hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|[state],"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Washington County Regional Medical Center,3/25/2024,2.0.0,Washington County Regional Medical Center,"610 Sparta Road Sandersville, GA 31082",201646672|GA,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AMBETTER PLAN,AMBETTER REIMBURSEMENT METHOD,AMERIGROUP PLAN,AMERIGROUP REIMBURSEMENT METHOD,AMERIGROUP PEACHCARE PLAN,AMERIGROUP PEACHCARE REIMBURSEMENT METHOD,ANTHEM BC HMO PLAN,ANTHEM BC HMO REIMBURSEMENT METHOD,ANTHEM BC POS PLAN,ANTHEM BC POS REIMBURSEMENT METHOD,ANTHEM BC OPEN ACCESS PLAN,ANTHEM BC OPEN ACCESS REIMBURSEMENT METHOD,ANTHEM BC INDEMNITY PAR PLAN,ANTHEM BC INDEMNITY PAR REIMBURSEMENT METHOD,ANTHEM BC PATHWAY PLAN,ANTHEM BC PATHWAY REIMBURSEMENT METHOD,ANTHEM BC PPO PLAN,ANTHEM BC PPO REIMBURSEMENT METHOD,ANTHEM MCR ADV HMO PLAN,ANTHEM MCR ADV HMO REIMBURSEMENT METHOD,ANTHEM MCR ADV PPO PLAN,ANTHEM MCR ADV PPO REIMBURSEMENT METHOD,CARESOURCE PLAN,CARESOURCE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,HUMANA HMO PLAN,HUMANA HMO REIMBURSEMENT METHOD,HUMANA POS PLAN,HUMANA POS REIMBURSEMENT METHOD,HUMANA MCR PPO PLAN,HUMANA MCR PPO REIMBURSEMENT METHOD,HUMANA PPO EPO PLAN,HUMANA PPO EPO REIMBURSEMENT METHOD,MULTIPLAN PLAN,MULTIPLAN REIMBURSEMENT METHOD,UHC HMO PLAN,UHC HMO REIMBURSEMENT METHOD,UHC PPO PLAN,UHC PPO REIMBURSEMENT METHOD,UHC MEDICARE HMO PLAN,UHC MEDICARE HMO REIMBURSEMENT METHOD,UHC MEDICARE PPO PLAN,UHC MEDICARE PPO REIMBURSEMENT METHOD,WELLCARE MEDICAID PLAN,WELLCARE MEDICAID REIMBURSEMENT METHOD,WELLCARE MEDICARE PLAN,WELLCARE MEDICARE REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE Outpatient Medical Services,OCCUPATIONAL THERAPY,97110,OT THERAPEUTIC EXERCISE PER 15 MI,431,$204.00 ,$142.80 ,70% of total billed charges for outpatient setting,$27.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$78.34 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$78.34 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$142.80 ,70% of billed charges for outpatient setting,$142.80 ,70% of billed charges for outpatient setting,$142.80 ,70% of billed charges for outpatient setting,$153.00 ,75% of billed charges for outpatient setting,$142.80 ,70% of billed charges for outpatient setting,$153.00 ,75% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.40 ,35% of billed charges for outpatient setting,$159.12 ,78% of billed charges for outpatient setting,$142.80 ,70% of billed charges for outpatient setting,$142.80 ,70% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$153.00 ,75% of billed charges for outpatient setting,$169.32 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.91 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,$424.00 ,$102.00 Outpatient Medical Services,OCCUPATIONAL THERAPY,97112,OT NEURO MUSCULAR RE-ED,431,$210.00 ,$147.00 ,70% of total billed charges for outpatient setting,$31.19 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$80.64 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$80.64 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$147.00 ,70% of billed charges for outpatient setting,$147.00 ,70% of billed charges for outpatient setting,$147.00 ,70% of billed charges for outpatient setting,$157.50 ,75% of billed charges for outpatient setting,$147.00 ,70% of billed charges for outpatient setting,$157.50 ,75% of billed charges for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.50 ,35% of billed charges for outpatient setting,$163.80 ,78% of billed charges for outpatient setting,$147.00 ,70% of billed charges for outpatient setting,$147.00 ,70% of billed charges for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.50 ,75% of billed charges for outpatient setting,$174.30 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.25 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,$424.00 ,$105.00 Outpatient Medical Services,OCCUPATIONAL THERAPY,97140,OT MANUAL THERAPY PER 15 MIN,431,$193.00 ,$135.10 ,70% of total billed charges for outpatient setting,$25.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$74.11 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$74.11 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$135.10 ,70% of billed charges for outpatient setting,$135.10 ,70% of billed charges for outpatient setting,$135.10 ,70% of billed charges for outpatient setting,$144.75 ,75% of billed charges for outpatient setting,$135.10 ,70% of billed charges for outpatient setting,$144.75 ,75% of billed charges for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.55 ,35% of billed charges for outpatient setting,$150.54 ,78% of billed charges for outpatient setting,$135.10 ,70% of billed charges for outpatient setting,$135.10 ,70% of billed charges for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$144.75 ,75% of billed charges for outpatient setting,$160.19 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.59 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,$424.00 ,$96.50 Outpatient Medical Services,OCCUPATIONAL THERAPY,97166,OT EVAL MOD COMPLEX 45 MIN,431,$473.00 ,$331.10 ,70% of total billed charges for outpatient setting,$94.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$181.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$181.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$165.55 ,35% of billed charges for outpatient setting,$368.94 ,78% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$392.59 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.26 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,$424.00 ,$236.50 Outpatient Medical Services,OCCUPATIONAL THERAPY,97167,OT EVAL HIGH COMPLEX 60 MIN,431,$537.00 ,$375.90 ,70% of total billed charges for outpatient setting,$94.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$206.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$206.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$375.90 ,70% of billed charges for outpatient setting,$375.90 ,70% of billed charges for outpatient setting,$375.90 ,70% of billed charges for outpatient setting,$402.75 ,75% of billed charges for outpatient setting,$375.90 ,70% of billed charges for outpatient setting,$402.75 ,75% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.95 ,35% of billed charges for outpatient setting,$418.86 ,78% of billed charges for outpatient setting,$375.90 ,70% of billed charges for outpatient setting,$375.90 ,70% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$402.75 ,75% of billed charges for outpatient setting,$445.71 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.33 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,$445.71 ,$268.50 Outpatient Medical Services,OCCUPATIONAL THERAPY,97530,OT THERAPEUTIC ACTIVIT PER 15 MIN,431,$163.00 ,$114.10 ,70% of total billed charges for outpatient setting,$33.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$62.59 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$62.59 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$114.10 ,70% of billed charges for outpatient setting,$114.10 ,70% of billed charges for outpatient setting,$114.10 ,70% of billed charges for outpatient setting,$122.25 ,75% of billed charges for outpatient setting,$114.10 ,70% of billed charges for outpatient setting,$122.25 ,75% of billed charges for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.05 ,35% of billed charges for outpatient setting,$127.14 ,78% of billed charges for outpatient setting,$114.10 ,70% of billed charges for outpatient setting,$114.10 ,70% of billed charges for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$122.25 ,75% of billed charges for outpatient setting,$135.29 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.84 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,$424.00 ,$81.50 Outpatient Medical Services,OCCUPATIONAL THERAPY,97542,OT WHEELCHAIR MANAGEMENT PER 15 M,431,$86.00 ,$60.20 ,70% of total billed charges for outpatient setting,$29.38 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$33.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$33.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.10 ,35% of billed charges for outpatient setting,$67.08 ,78% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$71.38 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.68 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$29.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.38 ,$424.00 ,$43.00 Outpatient Medical Services,OCCUPATIONAL THERAPY,97165,OT EVAL LOW COMPLEX 30 MIN,431,$489.00 ,$342.30 ,70% of total billed charges for outpatient setting,$94.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$187.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$187.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.15 ,35% of billed charges for outpatient setting,$381.42 ,78% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$405.87 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.54 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.11 ,$424.00 ,$244.50 Outpatient Medical Services,SPEECH THERAPY,92506,ST EVALUATION,440,$129.00 ,$90.30 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$49.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$49.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$90.30 ,70% of billed charges for outpatient setting,$90.30 ,70% of billed charges for outpatient setting,$90.30 ,70% of billed charges for outpatient setting,$96.75 ,75% of billed charges for outpatient setting,$90.30 ,70% of billed charges for outpatient setting,$96.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$45.15 ,35% of billed charges for outpatient setting,$100.62 ,78% of billed charges for outpatient setting,$90.30 ,70% of billed charges for outpatient setting,$90.30 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$96.75 ,75% of billed charges for outpatient setting,$107.07 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$50.53 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$45.15 ,$424.00 ,$64.50 Outpatient Medical Services,SPEECH THERAPY,92507,SLP THERAPY,440,$194.00 ,$135.80 ,70% of total billed charges for outpatient setting,$71.42 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$74.50 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$74.50 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$135.80 ,70% of billed charges for outpatient setting,$135.80 ,70% of billed charges for outpatient setting,$135.80 ,70% of billed charges for outpatient setting,$145.50 ,75% of billed charges for outpatient setting,$135.80 ,70% of billed charges for outpatient setting,$145.50 ,75% of billed charges for outpatient setting,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.90 ,35% of billed charges for outpatient setting,$151.32 ,78% of billed charges for outpatient setting,$135.80 ,70% of billed charges for outpatient setting,$135.80 ,70% of billed charges for outpatient setting,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$145.50 ,75% of billed charges for outpatient setting,$161.02 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.99 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$71.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.90 ,$424.00 ,$97.00 Outpatient Medical Services,SPEECH THERAPY,92523,ST EVALUATION SOUND PRODUCTION LA,440,$490.00 ,$343.00 ,70% of total billed charges for outpatient setting,$213.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$188.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$188.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$343.00 ,70% of billed charges for outpatient setting,$343.00 ,70% of billed charges for outpatient setting,$343.00 ,70% of billed charges for outpatient setting,$367.50 ,75% of billed charges for outpatient setting,$343.00 ,70% of billed charges for outpatient setting,$367.50 ,75% of billed charges for outpatient setting,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.50 ,35% of billed charges for outpatient setting,$382.20 ,78% of billed charges for outpatient setting,$343.00 ,70% of billed charges for outpatient setting,$343.00 ,70% of billed charges for outpatient setting,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$367.50 ,75% of billed charges for outpatient setting,$406.70 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.92 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$213.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.50 ,$424.00 ,$245.00 Outpatient Medical Services,SPEECH THERAPY,92526,ST TREATMENT SWALLOWING/ORAL/FEED,440,$235.00 ,$164.50 ,70% of total billed charges for outpatient setting,$78.81 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$90.24 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$90.24 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.25 ,35% of billed charges for outpatient setting,$183.30 ,78% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$195.05 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.04 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.81 ,$424.00 ,$117.50 Outpatient Medical Services,SPEECH THERAPY,92610,ST EVAL FOR SWALLOWING/ORAL/PHARY,440,$203.00 ,$142.10 ,70% of total billed charges for outpatient setting,$66.01 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$77.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$77.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.05 ,35% of billed charges for outpatient setting,$158.34 ,78% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$168.49 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.51 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$66.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.01 ,$424.00 ,$101.50 Outpatient Medical Services,SPEECH THERAPY,G0378,OBSERVATION HOURS AUTO OBS,762,$9.00 ,$6.30 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.46 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$3.46 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$6.30 ,100% Anthem fee schedule for outpatient setting,$6.30 ,100% Anthem fee schedule for outpatient setting,$6.30 ,100% Anthem fee schedule for outpatient setting,$6.75 ,100% Anthem fee schedule for outpatient setting,$6.30 ,100% Anthem fee schedule for outpatient setting,$6.75 ,100% Anthem fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.15 ,35% of billed charges for outpatient setting,$7.02 ,78% of billed charges for outpatient setting,$6.30 ,70% of billed charges for outpatient setting,$6.30 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$6.75 ,75% of billed charges for outpatient setting,$7.47 ,83% of billed charges for outpatient setting,$4.50 ,50% of billed charges for outpatient setting,$4.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.53 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$3.15 ,$7.47 ,$4.50 Outpatient Medical Services,WOUND CARE,11042,DEBRIDEMENT SUBQ (1ST 20SQ CM),761,$289.00 ,$202.30 ,70% of total billed charges for outpatient setting,$342.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$110.98 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$110.98 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$202.30 ,70% of billed charges for outpatient setting,$202.30 ,70% of billed charges for outpatient setting,$202.30 ,70% of billed charges for outpatient setting,$216.75 ,75% of billed charges for outpatient setting,$202.30 ,70% of billed charges for outpatient setting,$216.75 ,75% of billed charges for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.15 ,35% of billed charges for outpatient setting,$225.42 ,78% of billed charges for outpatient setting,$202.30 ,70% of billed charges for outpatient setting,$202.30 ,70% of billed charges for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$216.75 ,75% of billed charges for outpatient setting,$239.87 ,83% of billed charges for outpatient setting,$144.50 ,50% of billed charges for outpatient setting,$144.50 ,50% of billed charges for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.20 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.15 ,$342.51 ,$144.50 Outpatient Medical Services,WOUND CARE,11045,DEBRIDEMENT SUBQ ADD'L 20SQ CM,761,$397.00 ,$277.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$152.45 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$152.45 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$138.95 ,35% of billed charges for outpatient setting,$309.66 ,78% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,$329.51 ,83% of billed charges for outpatient setting,$198.50 ,50% of billed charges for outpatient setting,$198.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$155.50 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$138.95 ,$329.51 ,$198.50 Outpatient Medical Services,WOUND CARE,97597,SELECTIVE DEBR (1ST 20SQ CM),761,$153.00 ,$107.10 ,70% of total billed charges for outpatient setting,$171.96 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$58.75 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$58.75 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$107.10 ,70% of billed charges for outpatient setting,$107.10 ,70% of billed charges for outpatient setting,$107.10 ,70% of billed charges for outpatient setting,$114.75 ,75% of billed charges for outpatient setting,$107.10 ,70% of billed charges for outpatient setting,$114.75 ,75% of billed charges for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.55 ,35% of billed charges for outpatient setting,$119.34 ,78% of billed charges for outpatient setting,$107.10 ,70% of billed charges for outpatient setting,$107.10 ,70% of billed charges for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$114.75 ,75% of billed charges for outpatient setting,$126.99 ,83% of billed charges for outpatient setting,$76.50 ,50% of billed charges for outpatient setting,$76.50 ,50% of billed charges for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.93 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.55 ,$171.96 ,$76.50 Outpatient Medical Services,WOUND CARE,99203,E&M NEW PT VISIT INTERMEDIATE,761,$257.00 ,$179.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$98.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$98.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$179.90 ,70% of billed charges for outpatient setting,$179.90 ,70% of billed charges for outpatient setting,$179.90 ,70% of billed charges for outpatient setting,$192.75 ,75% of billed charges for outpatient setting,$179.90 ,70% of billed charges for outpatient setting,$192.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$89.95 ,35% of billed charges for outpatient setting,$200.46 ,78% of billed charges for outpatient setting,$179.90 ,70% of billed charges for outpatient setting,$179.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$192.75 ,75% of billed charges for outpatient setting,$213.31 ,83% of billed charges for outpatient setting,$128.50 ,50% of billed charges for outpatient setting,$128.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$100.66 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$89.95 ,$213.31 ,$128.50 Outpatient Medical Services,WOUND CARE,99204,E&M NEW PT VISIT EXTENDED,761,$330.00 ,$231.00 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$126.72 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$126.72 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$231.00 ,70% of billed charges for outpatient setting,$231.00 ,70% of billed charges for outpatient setting,$231.00 ,70% of billed charges for outpatient setting,$247.50 ,75% of billed charges for outpatient setting,$231.00 ,70% of billed charges for outpatient setting,$247.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$115.50 ,35% of billed charges for outpatient setting,$257.40 ,78% of billed charges for outpatient setting,$231.00 ,70% of billed charges for outpatient setting,$231.00 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$247.50 ,75% of billed charges for outpatient setting,$273.90 ,83% of billed charges for outpatient setting,$165.00 ,50% of billed charges for outpatient setting,$165.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$129.25 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$115.50 ,$273.90 ,$165.00 Outpatient Medical Services,WOUND CARE,99205,E&M NEW PT VISIT COMPLEX,761,$435.00 ,$304.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$167.04 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$167.04 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$304.50 ,70% of billed charges for outpatient setting,$304.50 ,70% of billed charges for outpatient setting,$304.50 ,70% of billed charges for outpatient setting,$326.25 ,75% of billed charges for outpatient setting,$304.50 ,70% of billed charges for outpatient setting,$326.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$152.25 ,35% of billed charges for outpatient setting,$339.30 ,78% of billed charges for outpatient setting,$304.50 ,70% of billed charges for outpatient setting,$304.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$326.25 ,75% of billed charges for outpatient setting,$361.05 ,83% of billed charges for outpatient setting,$217.50 ,50% of billed charges for outpatient setting,$217.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$170.38 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$152.25 ,$361.05 ,$217.50 Outpatient Medical Services,WOUND CARE,99211,E&M ESTABLISHED PT VISIT BRIEF,761,$67.00 ,$46.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$23.45 ,35% of billed charges for outpatient setting,$52.26 ,78% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$55.61 ,83% of billed charges for outpatient setting,$33.50 ,50% of billed charges for outpatient setting,$33.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$26.24 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$23.45 ,$55.61 ,$33.50 Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT EXTEN,761,$237.00 ,$165.90 ,70% of total billed charges for outpatient setting,$113.54 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$91.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$91.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$165.90 ,70% of billed charges for outpatient setting,$165.90 ,70% of billed charges for outpatient setting,$165.90 ,70% of billed charges for outpatient setting,$177.75 ,75% of billed charges for outpatient setting,$165.90 ,70% of billed charges for outpatient setting,$177.75 ,75% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.95 ,35% of billed charges for outpatient setting,$184.86 ,78% of billed charges for outpatient setting,$165.90 ,70% of billed charges for outpatient setting,$165.90 ,70% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.75 ,75% of billed charges for outpatient setting,$196.71 ,83% of billed charges for outpatient setting,$118.50 ,50% of billed charges for outpatient setting,$118.50 ,50% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.83 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.95 ,$196.71 ,$118.50 Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT INTER,761,$192.00 ,$134.40 ,70% of total billed charges for outpatient setting,$113.54 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$73.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$73.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$134.40 ,70% of billed charges for outpatient setting,$134.40 ,70% of billed charges for outpatient setting,$134.40 ,70% of billed charges for outpatient setting,$144.00 ,75% of billed charges for outpatient setting,$134.40 ,70% of billed charges for outpatient setting,$144.00 ,75% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.20 ,35% of billed charges for outpatient setting,$149.76 ,78% of billed charges for outpatient setting,$134.40 ,70% of billed charges for outpatient setting,$134.40 ,70% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$144.00 ,75% of billed charges for outpatient setting,$159.36 ,83% of billed charges for outpatient setting,$96.00 ,50% of billed charges for outpatient setting,$96.00 ,50% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.20 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.20 ,$159.36 ,$96.00 Outpatient Medical Services,WOUND CARE,G0463,E&M ESTABLISHED PT VISIT COMPL,761,$331.00 ,$231.70 ,70% of total billed charges for outpatient setting,$113.54 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$127.10 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$127.10 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$231.70 ,70% of billed charges for outpatient setting,$231.70 ,70% of billed charges for outpatient setting,$231.70 ,70% of billed charges for outpatient setting,$248.25 ,75% of billed charges for outpatient setting,$231.70 ,70% of billed charges for outpatient setting,$248.25 ,75% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$115.85 ,35% of billed charges for outpatient setting,$258.18 ,78% of billed charges for outpatient setting,$231.70 ,70% of billed charges for outpatient setting,$231.70 ,70% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$248.25 ,75% of billed charges for outpatient setting,$274.73 ,83% of billed charges for outpatient setting,$165.50 ,50% of billed charges for outpatient setting,$165.50 ,50% of billed charges for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$129.64 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$113.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.54 ,$274.73 ,$165.50 Outpatient Medical Services,SLEEP STUDY,95806,HOME SLEEP TEST TYPE III,740,"$1,146.00 ",$802.20 ,70% of total billed charges for outpatient setting,$134.16 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$440.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$440.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$802.20 ,70% of billed charges for outpatient setting,$802.20 ,70% of billed charges for outpatient setting,$802.20 ,70% of billed charges for outpatient setting,$859.50 ,75% of billed charges for outpatient setting,$802.20 ,70% of billed charges for outpatient setting,$859.50 ,75% of billed charges for outpatient setting,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$401.10 ,35% of billed charges for outpatient setting,$893.88 ,78% of billed charges for outpatient setting,$802.20 ,70% of billed charges for outpatient setting,$802.20 ,70% of billed charges for outpatient setting,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$859.50 ,75% of billed charges for outpatient setting,$951.18 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$448.86 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$134.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.16 ,$951.18 ,$573.00 Outpatient Medical Services,SLEEP STUDY,95810,SLEEP STUDY PSG,740,"$2,389.00 ","$1,672.30 ",70% of total billed charges for outpatient setting,$898.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$917.38 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$917.38 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,672.30 ",70% of billed charges for outpatient setting,"$1,672.30 ",70% of billed charges for outpatient setting,"$1,672.30 ",70% of billed charges for outpatient setting,"$1,791.75 ",75% of billed charges for outpatient setting,"$1,672.30 ",70% of billed charges for outpatient setting,"$1,791.75 ",75% of billed charges for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$836.15 ,35% of billed charges for outpatient setting,"$1,863.42 ",78% of billed charges for outpatient setting,"$1,672.30 ",70% of billed charges for outpatient setting,"$1,672.30 ",70% of billed charges for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,791.75 ",75% of billed charges for outpatient setting,"$1,982.87 ",83% of billed charges for outpatient setting,"$1,273.00 ",100% UHC case rate for outpatient setting,"$1,273.00 ",100% UHC case rate for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$935.73 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$836.15 ,"$1,982.87 ","$1,194.50 " Outpatient Medical Services,SLEEP STUDY,95811,SLEEP STUDY WITH TITRATION,740,"$2,486.00 ","$1,740.20 ",70% of total billed charges for outpatient setting,$898.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$954.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$954.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,740.20 ",70% of billed charges for outpatient setting,"$1,740.20 ",70% of billed charges for outpatient setting,"$1,740.20 ",70% of billed charges for outpatient setting,"$1,864.50 ",75% of billed charges for outpatient setting,"$1,740.20 ",70% of billed charges for outpatient setting,"$1,864.50 ",75% of billed charges for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$870.10 ,35% of billed charges for outpatient setting,"$1,939.08 ",78% of billed charges for outpatient setting,"$1,740.20 ",70% of billed charges for outpatient setting,"$1,740.20 ",70% of billed charges for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,864.50 ",75% of billed charges for outpatient setting,"$2,063.38 ",83% of billed charges for outpatient setting,"$1,273.00 ",100% UHC case rate for outpatient setting,"$1,273.00 ",100% UHC case rate for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$973.71 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$898.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$870.10 ,"$2,063.38 ","$1,243.00 " Outpatient Medical Services,CARDIOLOGY,93306,ECHO TRANSTHORACIC,483,"$3,190.00 ","$2,233.00 ",70% of total billed charges for outpatient setting,$473.87 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,224.96 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,224.96 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$2,233.00 ",70% of billed charges for outpatient setting,"$2,233.00 ",70% of billed charges for outpatient setting,"$2,233.00 ",70% of billed charges for outpatient setting,"$2,392.50 ",75% of billed charges for outpatient setting,"$2,233.00 ",70% of billed charges for outpatient setting,"$2,392.50 ",75% of billed charges for outpatient setting,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,116.50 ",35% of billed charges for outpatient setting,"$2,488.20 ",78% of billed charges for outpatient setting,"$2,233.00 ",70% of billed charges for outpatient setting,"$2,233.00 ",70% of billed charges for outpatient setting,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,392.50 ",75% of billed charges for outpatient setting,"$2,647.70 ",83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,249.46 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$473.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$424.00 ,"$2,647.70 ","$1,595.00 " Outpatient Medical Services,CARDIOLOGY,93005,EKG,730,$169.00 ,$118.30 ,70% of total billed charges for outpatient setting,$52.54 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$64.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$64.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.15 ,35% of billed charges for outpatient setting,$131.82 ,78% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$140.27 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.20 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,$424.00 ,$84.50 Outpatient Medical Services,CARDIOLOGY,93225,HOLTER MONITOR 48 HR,731,$694.00 ,$485.80 ,70% of total billed charges for outpatient setting,$109.72 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$266.50 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$266.50 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$485.80 ,70% of billed charges for outpatient setting,$485.80 ,70% of billed charges for outpatient setting,$485.80 ,70% of billed charges for outpatient setting,$520.50 ,75% of billed charges for outpatient setting,$485.80 ,70% of billed charges for outpatient setting,$520.50 ,75% of billed charges for outpatient setting,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$242.90 ,35% of billed charges for outpatient setting,$541.32 ,78% of billed charges for outpatient setting,$485.80 ,70% of billed charges for outpatient setting,$485.80 ,70% of billed charges for outpatient setting,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$520.50 ,75% of billed charges for outpatient setting,$576.02 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$271.83 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$109.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$109.72 ,$576.02 ,$347.00 Outpatient Medical Services,CARDIOLOGY,93226,HOLTER SCANNING,731,$638.00 ,$446.60 ,70% of total billed charges for outpatient setting,$52.54 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$244.99 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$244.99 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$446.60 ,70% of billed charges for outpatient setting,$446.60 ,70% of billed charges for outpatient setting,$446.60 ,70% of billed charges for outpatient setting,$478.50 ,75% of billed charges for outpatient setting,$446.60 ,70% of billed charges for outpatient setting,$478.50 ,75% of billed charges for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$223.30 ,35% of billed charges for outpatient setting,$497.64 ,78% of billed charges for outpatient setting,$446.60 ,70% of billed charges for outpatient setting,$446.60 ,70% of billed charges for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$478.50 ,75% of billed charges for outpatient setting,$529.54 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.89 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$52.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.54 ,$529.54 ,$319.00 Outpatient Medical Services,CARDIOLOGY,G0237,CR THERAPEUTIC PROC FOR ENDURANCE,419,$82.00 ,$57.40 ,70% of total billed charges for outpatient setting,$25.57 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.70 ,35% of billed charges for outpatient setting,$63.96 ,78% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$68.06 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.12 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,$212.00 ,$41.00 Outpatient Medical Services,CARDIOLOGY,G0238,CR THERAPEUTIC PROC FOR RESPIRATORY,419,$82.00 ,$57.40 ,70% of total billed charges for outpatient setting,$25.57 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.70 ,35% of billed charges for outpatient setting,$63.96 ,78% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$68.06 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.12 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$25.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,$212.00 ,$41.00 Outpatient Medical Services,CARDIOLOGY,93798,CR PHASE II CARDIAC EXERCISE,943,$402.00 ,$281.40 ,70% of total billed charges for outpatient setting,$113.50 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$154.37 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$154.37 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$281.40 ,70% of billed charges for outpatient setting,$281.40 ,70% of billed charges for outpatient setting,$281.40 ,70% of billed charges for outpatient setting,$301.50 ,75% of billed charges for outpatient setting,$281.40 ,70% of billed charges for outpatient setting,$301.50 ,75% of billed charges for outpatient setting,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.70 ,35% of billed charges for outpatient setting,$313.56 ,78% of billed charges for outpatient setting,$281.40 ,70% of billed charges for outpatient setting,$281.40 ,70% of billed charges for outpatient setting,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$301.50 ,75% of billed charges for outpatient setting,$333.66 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.46 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$113.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.50 ,$424.00 ,$201.00 Outpatient Medical Services,REHAB,97110,PT THERAPEUTIC EXERCISE PER 15 MIN,421,$212.00 ,$148.40 ,70% of total billed charges for outpatient setting,$27.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$81.41 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$81.41 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$148.40 ,70% of billed charges for outpatient setting,$148.40 ,70% of billed charges for outpatient setting,$148.40 ,70% of billed charges for outpatient setting,$159.00 ,75% of billed charges for outpatient setting,$148.40 ,70% of billed charges for outpatient setting,$159.00 ,75% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.20 ,35% of billed charges for outpatient setting,$165.36 ,78% of billed charges for outpatient setting,$148.40 ,70% of billed charges for outpatient setting,$148.40 ,70% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$159.00 ,75% of billed charges for outpatient setting,$175.96 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$83.04 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,$424.00 ,$106.00 Outpatient Medical Services,REHAB,97112,PT NEURO MUSCULAR RE ED PER 15 MI,421,$239.00 ,$167.30 ,70% of total billed charges for outpatient setting,$31.19 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$91.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$91.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$167.30 ,70% of billed charges for outpatient setting,$167.30 ,70% of billed charges for outpatient setting,$167.30 ,70% of billed charges for outpatient setting,$179.25 ,75% of billed charges for outpatient setting,$167.30 ,70% of billed charges for outpatient setting,$179.25 ,75% of billed charges for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$83.65 ,35% of billed charges for outpatient setting,$186.42 ,78% of billed charges for outpatient setting,$167.30 ,70% of billed charges for outpatient setting,$167.30 ,70% of billed charges for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$179.25 ,75% of billed charges for outpatient setting,$198.37 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.62 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$31.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.19 ,$424.00 ,$119.50 Outpatient Medical Services,REHAB,97116,PT GAIT TRAINING PER 15 MIN,421,$67.00 ,$46.90 ,70% of total billed charges for outpatient setting,$27.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.45 ,35% of billed charges for outpatient setting,$52.26 ,78% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$55.61 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.24 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$27.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.45 ,$424.00 ,$33.50 Outpatient Medical Services,REHAB,97161,PT EVAL LOW COMPLEX 20 MIN,421,$473.00 ,$331.10 ,70% of total billed charges for outpatient setting,$93.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$181.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$181.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$165.55 ,35% of billed charges for outpatient setting,$368.94 ,78% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$331.10 ,70% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.75 ,75% of billed charges for outpatient setting,$392.59 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.26 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,$424.00 ,$236.50 Outpatient Medical Services,REHAB,97163,PT EVAL HIGH COMPLEX 45 MIN,421,$489.00 ,$342.30 ,70% of total billed charges for outpatient setting,$93.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$187.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$187.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.15 ,35% of billed charges for outpatient setting,$381.42 ,78% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$342.30 ,70% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$366.75 ,75% of billed charges for outpatient setting,$405.87 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.54 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,$424.00 ,$244.50 Outpatient Medical Services,REHAB,97530,PT THERAPEUTIC ACTIVITIES PER 15,421,$162.00 ,$113.40 ,70% of total billed charges for outpatient setting,$33.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$62.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$62.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$113.40 ,70% of billed charges for outpatient setting,$113.40 ,70% of billed charges for outpatient setting,$113.40 ,70% of billed charges for outpatient setting,$121.50 ,75% of billed charges for outpatient setting,$113.40 ,70% of billed charges for outpatient setting,$121.50 ,75% of billed charges for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.70 ,35% of billed charges for outpatient setting,$126.36 ,78% of billed charges for outpatient setting,$113.40 ,70% of billed charges for outpatient setting,$113.40 ,70% of billed charges for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$121.50 ,75% of billed charges for outpatient setting,$134.46 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.45 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$33.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.56 ,$424.00 ,$81.00 Outpatient Medical Services,REHAB,97140,PT MANUAL THERAPY PER 15 MIN,421,$203.00 ,$142.10 ,70% of total billed charges for outpatient setting,$25.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$77.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$77.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.05 ,35% of billed charges for outpatient setting,$158.34 ,78% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$142.10 ,70% of billed charges for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$152.25 ,75% of billed charges for outpatient setting,$168.49 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.51 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$25.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.14 ,$424.00 ,$101.50 Outpatient Medical Services,REHAB,97162,PT EVAL MOD COMPLEX 30 MIN,421,$470.00 ,$329.00 ,70% of total billed charges for outpatient setting,$93.24 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$180.48 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$180.48 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$329.00 ,70% of billed charges for outpatient setting,$329.00 ,70% of billed charges for outpatient setting,$329.00 ,70% of billed charges for outpatient setting,$352.50 ,75% of billed charges for outpatient setting,$329.00 ,70% of billed charges for outpatient setting,$352.50 ,75% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$164.50 ,35% of billed charges for outpatient setting,$366.60 ,78% of billed charges for outpatient setting,$329.00 ,70% of billed charges for outpatient setting,$329.00 ,70% of billed charges for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$352.50 ,75% of billed charges for outpatient setting,$390.10 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.09 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$93.24 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.24 ,$424.00 ,$235.00 Outpatient Medical Services,SURGERY,45378,COLONOSCOPY SCREENING,360,"$1,753.00 ","$1,227.10 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$673.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$673.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,227.10 ",70% of billed charges for outpatient setting,"$1,227.10 ",70% of billed charges for outpatient setting,"$1,227.10 ",70% of billed charges for outpatient setting,"$1,314.75 ",75% of billed charges for outpatient setting,"$1,227.10 ",70% of billed charges for outpatient setting,"$1,314.75 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$613.55 ,35% of billed charges for outpatient setting,"$1,367.34 ",78% of billed charges for outpatient setting,"$1,227.10 ",70% of billed charges for outpatient setting,"$1,227.10 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,314.75 ",75% of billed charges for outpatient setting,"$1,454.99 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$686.61 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$613.55 ,"$2,175.00 ",$876.50 Outpatient Medical Services,SURGERY,31231,"ENDOSCOPY, UPPER/DX",360,"$1,785.00 ","$1,249.50 ",70% of total billed charges for outpatient setting,$170.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$685.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$685.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,249.50 ",70% of billed charges for outpatient setting,"$1,249.50 ",70% of billed charges for outpatient setting,"$1,249.50 ",70% of billed charges for outpatient setting,"$1,338.75 ",75% of billed charges for outpatient setting,"$1,249.50 ",70% of billed charges for outpatient setting,"$1,338.75 ",75% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$624.75 ,35% of billed charges for outpatient setting,"$1,392.30 ",78% of billed charges for outpatient setting,"$1,249.50 ",70% of billed charges for outpatient setting,"$1,249.50 ",70% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,338.75 ",75% of billed charges for outpatient setting,"$1,481.55 ",83% of billed charges for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$699.15 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,"$1,481.55 ",$892.50 Outpatient Medical Services,SURGERY,31231,"ENDOSCOPY, UPPER/BX",360,"$1,927.00 ","$1,348.90 ",70% of total billed charges for outpatient setting,$170.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$739.97 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$739.97 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,348.90 ",70% of billed charges for outpatient setting,"$1,348.90 ",70% of billed charges for outpatient setting,"$1,348.90 ",70% of billed charges for outpatient setting,"$1,445.25 ",75% of billed charges for outpatient setting,"$1,348.90 ",70% of billed charges for outpatient setting,"$1,445.25 ",75% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$674.45 ,35% of billed charges for outpatient setting,"$1,503.06 ",78% of billed charges for outpatient setting,"$1,348.90 ",70% of billed charges for outpatient setting,"$1,348.90 ",70% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,445.25 ",75% of billed charges for outpatient setting,"$1,599.41 ",83% of billed charges for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$754.77 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,"$1,599.41 ",$963.50 Outpatient Medical Services,SURGERY,31231,SURGICAL REPROCESSING,360,$37.00 ,$25.90 ,70% of total billed charges for outpatient setting,$170.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$14.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$14.21 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.95 ,35% of billed charges for outpatient setting,$28.86 ,78% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$30.71 ,83% of billed charges for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.49 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$170.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.95 ,$659.00 ,$18.50 Outpatient Medical Services,SURGERY,45378,COLONOSCOPY & POLYP,360,"$2,503.00 ","$1,752.10 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$961.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$961.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,752.10 ",70% of billed charges for outpatient setting,"$1,752.10 ",70% of billed charges for outpatient setting,"$1,752.10 ",70% of billed charges for outpatient setting,"$1,877.25 ",75% of billed charges for outpatient setting,"$1,752.10 ",70% of billed charges for outpatient setting,"$1,877.25 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$876.05 ,35% of billed charges for outpatient setting,"$1,952.34 ",78% of billed charges for outpatient setting,"$1,752.10 ",70% of billed charges for outpatient setting,"$1,752.10 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,877.25 ",75% of billed charges for outpatient setting,"$2,077.49 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$980.37 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,"$2,175.00 ","$1,251.50 " Outpatient Medical Services,SURGERY,45378,COLONOSCOPY HIGH RISK,360,"$1,952.00 ","$1,366.40 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$749.57 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$749.57 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,366.40 ",70% of billed charges for outpatient setting,"$1,366.40 ",70% of billed charges for outpatient setting,"$1,366.40 ",70% of billed charges for outpatient setting,"$1,464.00 ",75% of billed charges for outpatient setting,"$1,366.40 ",70% of billed charges for outpatient setting,"$1,464.00 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$683.20 ,35% of billed charges for outpatient setting,"$1,522.56 ",78% of billed charges for outpatient setting,"$1,366.40 ",70% of billed charges for outpatient setting,"$1,366.40 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,464.00 ",75% of billed charges for outpatient setting,"$1,620.16 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$764.56 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$683.20 ,"$2,175.00 ",$976.00 Outpatient Medical Services,SURGERY,45378,"COLONOSCOPY, DX",360,"$1,937.00 ","$1,355.90 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$743.81 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$743.81 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,355.90 ",70% of billed charges for outpatient setting,"$1,355.90 ",70% of billed charges for outpatient setting,"$1,355.90 ",70% of billed charges for outpatient setting,"$1,452.75 ",75% of billed charges for outpatient setting,"$1,355.90 ",70% of billed charges for outpatient setting,"$1,452.75 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$677.95 ,35% of billed charges for outpatient setting,"$1,510.86 ",78% of billed charges for outpatient setting,"$1,355.90 ",70% of billed charges for outpatient setting,"$1,355.90 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,452.75 ",75% of billed charges for outpatient setting,"$1,607.71 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$758.69 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$677.95 ,"$2,175.00 ",$968.50 Outpatient Medical Services,SURGERY,45378,COLONOSCOPY/MU POLY,360,"$2,629.00 ","$1,840.30 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,009.54 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,009.54 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,840.30 ",70% of billed charges for outpatient setting,"$1,840.30 ",70% of billed charges for outpatient setting,"$1,840.30 ",70% of billed charges for outpatient setting,"$1,971.75 ",75% of billed charges for outpatient setting,"$1,840.30 ",70% of billed charges for outpatient setting,"$1,971.75 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$920.15 ,35% of billed charges for outpatient setting,"$2,050.62 ",78% of billed charges for outpatient setting,"$1,840.30 ",70% of billed charges for outpatient setting,"$1,840.30 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,971.75 ",75% of billed charges for outpatient setting,"$2,182.07 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,029.73 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,"$2,182.07 ","$1,314.50 " Outpatient Medical Services,SURGERY,20206,BX SOFT TISSUE,360,"$1,721.00 ","$1,204.70 ",70% of total billed charges for outpatient setting,"$1,392.65 ",130% CMS Medicare OPPS fee schedule for outpatient setting,$660.86 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$660.86 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,290.75 ",75% of billed charges for outpatient setting,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,290.75 ",75% of billed charges for outpatient setting,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$602.35 ,35% of billed charges for outpatient setting,"$1,342.38 ",78% of billed charges for outpatient setting,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,204.70 ",70% of billed charges for outpatient setting,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,290.75 ",75% of billed charges for outpatient setting,"$1,428.43 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$674.08 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$1,392.65 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$602.35 ,"$2,175.00 ",$860.50 Outpatient Medical Services,SURGERY,29907,ARTHROSCOPY,360,"$5,013.00 ","$3,509.10 ",70% of total billed charges for outpatient setting,"$11,305.14 ",130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,924.99 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,924.99 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$3,509.10 ",70% of billed charges for outpatient setting,"$3,509.10 ",70% of billed charges for outpatient setting,"$3,509.10 ",70% of billed charges for outpatient setting,"$3,759.75 ",75% of billed charges for outpatient setting,"$3,509.10 ",70% of billed charges for outpatient setting,"$3,759.75 ",75% of billed charges for outpatient setting,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,754.55 ",35% of billed charges for outpatient setting,"$3,910.14 ",78% of billed charges for outpatient setting,"$3,509.10 ",70% of billed charges for outpatient setting,"$3,509.10 ",70% of billed charges for outpatient setting,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,759.75 ",75% of billed charges for outpatient setting,"$4,160.79 ",83% of billed charges for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,963.49 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$11,305.14 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,754.55 ","$11,305.14 ","$2,506.50 " Outpatient Medical Services,SURGERY,49650,LAP HERNIA,360,"$10,133.00 ","$7,093.10 ",70% of total billed charges for outpatient setting,"$4,956.29 ",130% CMS Medicare OPPS fee schedule for outpatient setting,"$3,891.07 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$3,891.07 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$7,093.10 ",70% of billed charges for outpatient setting,"$7,093.10 ",70% of billed charges for outpatient setting,"$7,093.10 ",70% of billed charges for outpatient setting,"$7,599.75 ",75% of billed charges for outpatient setting,"$7,093.10 ",70% of billed charges for outpatient setting,"$7,599.75 ",75% of billed charges for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,546.55 ",35% of billed charges for outpatient setting,"$7,903.74 ",78% of billed charges for outpatient setting,"$7,093.10 ",70% of billed charges for outpatient setting,"$7,093.10 ",70% of billed charges for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$7,599.75 ",75% of billed charges for outpatient setting,"$8,410.39 ",83% of billed charges for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,968.89 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,546.55 ","$8,410.39 ","$5,066.50 " Outpatient Medical Services,SURGERY,99202,MINOR PROCEDURE,360,"$1,667.00 ","$1,166.90 ",70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$640.13 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$640.13 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,166.90 ",70% of billed charges for outpatient setting,"$1,166.90 ",70% of billed charges for outpatient setting,"$1,166.90 ",70% of billed charges for outpatient setting,"$1,250.25 ",75% of billed charges for outpatient setting,"$1,166.90 ",70% of billed charges for outpatient setting,"$1,250.25 ",75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$583.45 ,35% of billed charges for outpatient setting,"$1,300.26 ",78% of billed charges for outpatient setting,"$1,166.90 ",70% of billed charges for outpatient setting,"$1,166.90 ",70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,"$1,250.25 ",75% of billed charges for outpatient setting,"$1,383.61 ",83% of billed charges for outpatient setting,$833.50 ,50% of billed charges for outpatient setting,$833.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$652.93 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$583.45 ,"$1,383.61 ",$833.50 Outpatient Medical Services,SURGERY,62310,EPIDURAL STEROID INJECTION W/ GUIDANCE,360,"$1,432.00 ","$1,002.40 ",70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$549.89 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$549.89 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,002.40 ",70% of billed charges for outpatient setting,"$1,002.40 ",70% of billed charges for outpatient setting,"$1,002.40 ",70% of billed charges for outpatient setting,"$1,074.00 ",75% of billed charges for outpatient setting,"$1,002.40 ",70% of billed charges for outpatient setting,"$1,074.00 ",75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$501.20 ,35% of billed charges for outpatient setting,"$1,116.96 ",78% of billed charges for outpatient setting,"$1,002.40 ",70% of billed charges for outpatient setting,"$1,002.40 ",70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,"$1,074.00 ",75% of billed charges for outpatient setting,"$1,188.56 ",83% of billed charges for outpatient setting,$716.00 ,50% of billed charges for outpatient setting,$716.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$560.89 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$501.20 ,"$1,188.56 ",$716.00 Outpatient Medical Services,SURGERY,45378,COLONOSCOPY & BX,360,"$2,347.00 ","$1,642.90 ",70% of total billed charges for outpatient setting,$785.07 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$901.25 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$901.25 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,642.90 ",70% of billed charges for outpatient setting,"$1,642.90 ",70% of billed charges for outpatient setting,"$1,642.90 ",70% of billed charges for outpatient setting,"$1,760.25 ",75% of billed charges for outpatient setting,"$1,642.90 ",70% of billed charges for outpatient setting,"$1,760.25 ",75% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$821.45 ,35% of billed charges for outpatient setting,"$1,830.66 ",78% of billed charges for outpatient setting,"$1,642.90 ",70% of billed charges for outpatient setting,"$1,642.90 ",70% of billed charges for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.25 ",75% of billed charges for outpatient setting,"$1,948.01 ",83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$919.28 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$785.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$785.07 ,"$2,175.00 ","$1,173.50 " Outpatient Medical Services,SURGERY,25608,ORIF,360,"$3,443.00 ","$2,410.10 ",70% of total billed charges for outpatient setting,"$6,145.19 ",130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,322.11 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,322.11 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$2,410.10 ",70% of billed charges for outpatient setting,"$2,410.10 ",70% of billed charges for outpatient setting,"$2,410.10 ",70% of billed charges for outpatient setting,"$2,582.25 ",75% of billed charges for outpatient setting,"$2,410.10 ",70% of billed charges for outpatient setting,"$2,582.25 ",75% of billed charges for outpatient setting,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,205.05 ",35% of billed charges for outpatient setting,"$2,685.54 ",78% of billed charges for outpatient setting,"$2,410.10 ",70% of billed charges for outpatient setting,"$2,410.10 ",70% of billed charges for outpatient setting,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,582.25 ",75% of billed charges for outpatient setting,"$2,857.69 ",83% of billed charges for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,348.55 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$6,145.19 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,205.05 ","$6,145.19 ","$1,721.50 " Outpatient Medical Services,SURGERY,64721,CARPEL TUNNEL RELEAS,360,"$1,143.00 ",$800.10 ,70% of total billed charges for outpatient setting,"$1,658.50 ",130% CMS Medicare OPPS fee schedule for outpatient setting,$438.91 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$438.91 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$800.10 ,70% of billed charges for outpatient setting,$800.10 ,70% of billed charges for outpatient setting,$800.10 ,70% of billed charges for outpatient setting,$857.25 ,75% of billed charges for outpatient setting,$800.10 ,70% of billed charges for outpatient setting,$857.25 ,75% of billed charges for outpatient setting,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$400.05 ,35% of billed charges for outpatient setting,$891.54 ,78% of billed charges for outpatient setting,$800.10 ,70% of billed charges for outpatient setting,$800.10 ,70% of billed charges for outpatient setting,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$857.25 ,75% of billed charges for outpatient setting,$948.69 ,83% of billed charges for outpatient setting,"$3,141.00 ",100% UHC ASC group fee schedule for outpatient setting,"$3,141.00 ",100% UHC ASC group fee schedule for outpatient setting,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$447.69 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$1,658.50 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$400.05 ,"$3,141.00 ",$571.50 Outpatient Medical Services,SURGERY,47562,LAP. CHOLECYSTECTOMY,360,"$8,654.00 ","$6,057.80 ",70% of total billed charges for outpatient setting,"$4,956.29 ",130% CMS Medicare OPPS fee schedule for outpatient setting,"$3,323.14 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$3,323.14 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$3,146.00 ",100% Anthem surgery case rate for outpatient setting,"$3,146.00 ",100% Anthem surgery case rate for outpatient setting,"$3,146.00 ",100% Anthem surgery case rate for outpatient setting,"$3,467.00 ",100% Anthem surgery case rate for outpatient setting,"$3,146.00 ",100% Anthem surgery case rate for outpatient setting,"$3,467.00 ",100% Anthem surgery case rate for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,028.90 ",35% of billed charges for outpatient setting,"$6,750.12 ",78% of billed charges for outpatient setting,"$6,057.80 ",70% of billed charges for outpatient setting,"$6,057.80 ",70% of billed charges for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,490.50 ",75% of billed charges for outpatient setting,"$7,182.82 ",83% of billed charges for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$5,560.00 ",100% UHC ASC group fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,389.60 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$4,956.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,028.90 ","$7,182.82 ","$4,327.00 " Outpatient Medical Services,SURGERY,10060,I & D,360,"$1,405.00 ",$983.50 ,70% of total billed charges for outpatient setting,$171.96 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$539.52 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$539.52 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$983.50 ,70% of billed charges for outpatient setting,$983.50 ,70% of billed charges for outpatient setting,$983.50 ,70% of billed charges for outpatient setting,"$1,053.75 ",75% of billed charges for outpatient setting,$983.50 ,70% of billed charges for outpatient setting,"$1,053.75 ",75% of billed charges for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$491.75 ,35% of billed charges for outpatient setting,"$1,095.90 ",78% of billed charges for outpatient setting,$983.50 ,70% of billed charges for outpatient setting,$983.50 ,70% of billed charges for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,053.75 ",75% of billed charges for outpatient setting,"$1,166.15 ",83% of billed charges for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$550.31 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$171.96 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.96 ,"$1,166.15 ",$702.50 Outpatient Medical Services,SURGERY,43246,PEG TUBE PROCEDURE,360,$842.00 ,$589.40 ,70% of total billed charges for outpatient setting,"$1,634.48 ",130% CMS Medicare OPPS fee schedule for outpatient setting,$323.33 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$323.33 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$589.40 ,70% of billed charges for outpatient setting,$589.40 ,70% of billed charges for outpatient setting,$589.40 ,70% of billed charges for outpatient setting,$631.50 ,75% of billed charges for outpatient setting,$589.40 ,70% of billed charges for outpatient setting,$631.50 ,75% of billed charges for outpatient setting,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$294.70 ,35% of billed charges for outpatient setting,$656.76 ,78% of billed charges for outpatient setting,$589.40 ,70% of billed charges for outpatient setting,$589.40 ,70% of billed charges for outpatient setting,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$631.50 ,75% of billed charges for outpatient setting,$698.86 ,83% of billed charges for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$2,175.00 ",100% UHC ASC group fee schedule for outpatient setting,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$329.80 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$1,634.48 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$294.70 ,"$2,175.00 ",$421.00 Outpatient Medical Services,SURGERY,11042,DEBRIDEMENT,360,"$1,282.00 ",$897.40 ,70% of total billed charges for outpatient setting,$342.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$492.29 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$492.29 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$897.40 ,70% of billed charges for outpatient setting,$897.40 ,70% of billed charges for outpatient setting,$897.40 ,70% of billed charges for outpatient setting,$961.50 ,75% of billed charges for outpatient setting,$897.40 ,70% of billed charges for outpatient setting,$961.50 ,75% of billed charges for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$448.70 ,35% of billed charges for outpatient setting,$999.96 ,78% of billed charges for outpatient setting,$897.40 ,70% of billed charges for outpatient setting,$897.40 ,70% of billed charges for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$961.50 ,75% of billed charges for outpatient setting,"$1,064.06 ",83% of billed charges for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$659.00 ,100% UHC ASC group fee schedule for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$502.14 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$342.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.51 ,"$1,064.06 ",$641.00 Outpatient Medical Services,EMERGENCY,90471,INJECTION VACCINE/TOXOID/RABIE,260,$88.00 ,$61.60 ,70% of total billed charges for outpatient setting,$60.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$33.79 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$33.79 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$61.60 ,70% of billed charges for outpatient setting,$61.60 ,70% of billed charges for outpatient setting,$61.60 ,70% of billed charges for outpatient setting,$66.00 ,75% of billed charges for outpatient setting,$61.60 ,70% of billed charges for outpatient setting,$66.00 ,75% of billed charges for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.80 ,35% of billed charges for outpatient setting,$68.64 ,78% of billed charges for outpatient setting,$61.60 ,70% of billed charges for outpatient setting,$61.60 ,70% of billed charges for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.00 ,75% of billed charges for outpatient setting,$73.04 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.47 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.80 ,$212.00 ,$44.00 Outpatient Medical Services,EMERGENCY,96360,IV INFUSION HYDRATION,260,$615.00 ,$430.50 ,70% of total billed charges for outpatient setting,$184.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$236.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$236.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$430.50 ,70% of billed charges for outpatient setting,$430.50 ,70% of billed charges for outpatient setting,$430.50 ,70% of billed charges for outpatient setting,$461.25 ,75% of billed charges for outpatient setting,$430.50 ,70% of billed charges for outpatient setting,$461.25 ,75% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$215.25 ,35% of billed charges for outpatient setting,$479.70 ,78% of billed charges for outpatient setting,$430.50 ,70% of billed charges for outpatient setting,$430.50 ,70% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$461.25 ,75% of billed charges for outpatient setting,$510.45 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$240.88 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,$510.45 ,$307.50 Outpatient Medical Services,EMERGENCY,96361,IV INFUSION HYDRATION EACH ADD,260,$161.00 ,$112.70 ,70% of total billed charges for outpatient setting,$40.79 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$61.82 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$61.82 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$112.70 ,70% of billed charges for outpatient setting,$112.70 ,70% of billed charges for outpatient setting,$112.70 ,70% of billed charges for outpatient setting,$120.75 ,75% of billed charges for outpatient setting,$112.70 ,70% of billed charges for outpatient setting,$120.75 ,75% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.35 ,35% of billed charges for outpatient setting,$125.58 ,78% of billed charges for outpatient setting,$112.70 ,70% of billed charges for outpatient setting,$112.70 ,70% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.75 ,75% of billed charges for outpatient setting,$133.63 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.06 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,$212.00 ,$80.50 Outpatient Medical Services,EMERGENCY,96365,IV INFUSION MED IST HOUR,260,$676.00 ,$473.20 ,70% of total billed charges for outpatient setting,$184.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$259.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$259.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$473.20 ,70% of billed charges for outpatient setting,$473.20 ,70% of billed charges for outpatient setting,$473.20 ,70% of billed charges for outpatient setting,$507.00 ,75% of billed charges for outpatient setting,$473.20 ,70% of billed charges for outpatient setting,$507.00 ,75% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$236.60 ,35% of billed charges for outpatient setting,$527.28 ,78% of billed charges for outpatient setting,$473.20 ,70% of billed charges for outpatient setting,$473.20 ,70% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$507.00 ,75% of billed charges for outpatient setting,$561.08 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$264.77 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,$561.08 ,$338.00 Outpatient Medical Services,EMERGENCY,96366,"IV INFUSION MED EACH ADD""L HOU",260,$44.00 ,$30.80 ,70% of total billed charges for outpatient setting,$40.79 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$16.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$16.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$30.80 ,70% of billed charges for outpatient setting,$30.80 ,70% of billed charges for outpatient setting,$30.80 ,70% of billed charges for outpatient setting,$33.00 ,75% of billed charges for outpatient setting,$30.80 ,70% of billed charges for outpatient setting,$33.00 ,75% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.40 ,35% of billed charges for outpatient setting,$34.32 ,78% of billed charges for outpatient setting,$30.80 ,70% of billed charges for outpatient setting,$30.80 ,70% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,75% of billed charges for outpatient setting,$36.52 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.24 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.40 ,$212.00 ,$22.00 Outpatient Medical Services,EMERGENCY,96376,IV PUSH SAME MED AFTER 30 MIN,260,$167.00 ,$116.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$64.13 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$64.13 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$116.90 ,70% of billed charges for outpatient setting,$116.90 ,70% of billed charges for outpatient setting,$116.90 ,70% of billed charges for outpatient setting,$125.25 ,75% of billed charges for outpatient setting,$116.90 ,70% of billed charges for outpatient setting,$125.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$58.45 ,35% of billed charges for outpatient setting,$130.26 ,78% of billed charges for outpatient setting,$116.90 ,70% of billed charges for outpatient setting,$116.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$125.25 ,75% of billed charges for outpatient setting,$138.61 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$65.41 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$58.45 ,$212.00 ,$83.50 Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT LONG ARM,450,$433.00 ,$303.10 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$166.27 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$166.27 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$303.10 ,70% of billed charges for outpatient setting,$303.10 ,70% of billed charges for outpatient setting,$303.10 ,70% of billed charges for outpatient setting,$324.75 ,75% of billed charges for outpatient setting,$303.10 ,70% of billed charges for outpatient setting,$324.75 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.55 ,35% of billed charges for outpatient setting,$337.74 ,78% of billed charges for outpatient setting,$303.10 ,70% of billed charges for outpatient setting,$303.10 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$324.75 ,75% of billed charges for outpatient setting,$359.39 ,83% of billed charges for outpatient setting,$216.50 ,50% of billed charges for outpatient setting,$216.50 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$169.60 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.55 ,$359.39 ,$216.50 Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT SHORT ARM,450,$668.00 ,$467.60 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$256.51 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$256.51 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$467.60 ,70% of billed charges for outpatient setting,$467.60 ,70% of billed charges for outpatient setting,$467.60 ,70% of billed charges for outpatient setting,$501.00 ,75% of billed charges for outpatient setting,$467.60 ,70% of billed charges for outpatient setting,$501.00 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$233.80 ,35% of billed charges for outpatient setting,$521.04 ,78% of billed charges for outpatient setting,$467.60 ,70% of billed charges for outpatient setting,$467.60 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$501.00 ,75% of billed charges for outpatient setting,$554.44 ,83% of billed charges for outpatient setting,$334.00 ,50% of billed charges for outpatient setting,$334.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$261.64 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,$554.44 ,$334.00 Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT FINGER,450,$242.00 ,$169.40 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$92.93 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$92.93 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$169.40 ,70% of billed charges for outpatient setting,$169.40 ,70% of billed charges for outpatient setting,$169.40 ,70% of billed charges for outpatient setting,$181.50 ,75% of billed charges for outpatient setting,$169.40 ,70% of billed charges for outpatient setting,$181.50 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.70 ,35% of billed charges for outpatient setting,$188.76 ,78% of billed charges for outpatient setting,$169.40 ,70% of billed charges for outpatient setting,$169.40 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$181.50 ,75% of billed charges for outpatient setting,$200.86 ,83% of billed charges for outpatient setting,$121.00 ,50% of billed charges for outpatient setting,$121.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.79 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.70 ,$202.56 ,$121.00 Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP SHOULDER,450,$82.00 ,$57.40 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$31.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.70 ,35% of billed charges for outpatient setting,$63.96 ,78% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$57.40 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.50 ,75% of billed charges for outpatient setting,$68.06 ,83% of billed charges for outpatient setting,$41.00 ,50% of billed charges for outpatient setting,$41.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.12 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.70 ,$202.56 ,$41.00 Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP ELBOW & WRIST,450,$61.00 ,$42.70 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$23.42 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$23.42 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$42.70 ,70% of billed charges for outpatient setting,$42.70 ,70% of billed charges for outpatient setting,$42.70 ,70% of billed charges for outpatient setting,$45.75 ,75% of billed charges for outpatient setting,$42.70 ,70% of billed charges for outpatient setting,$45.75 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.35 ,35% of billed charges for outpatient setting,$47.58 ,78% of billed charges for outpatient setting,$42.70 ,70% of billed charges for outpatient setting,$42.70 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.75 ,75% of billed charges for outpatient setting,$50.63 ,83% of billed charges for outpatient setting,$30.50 ,50% of billed charges for outpatient setting,$30.50 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.89 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.35 ,$202.56 ,$30.50 Outpatient Medical Services,EMERGENCY,26605,STRAP HAND & FINGER,450,$116.00 ,$81.20 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$44.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,35% of billed charges for outpatient setting,$90.48 ,78% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$96.28 ,83% of billed charges for outpatient setting,$58.00 ,50% of billed charges for outpatient setting,$58.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.43 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.60 ,$202.56 ,$58.00 Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT LONG LEG,450,$606.00 ,$424.20 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$232.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$232.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$424.20 ,70% of billed charges for outpatient setting,$424.20 ,70% of billed charges for outpatient setting,$424.20 ,70% of billed charges for outpatient setting,$454.50 ,75% of billed charges for outpatient setting,$424.20 ,70% of billed charges for outpatient setting,$454.50 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$212.10 ,35% of billed charges for outpatient setting,$472.68 ,78% of billed charges for outpatient setting,$424.20 ,70% of billed charges for outpatient setting,$424.20 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$454.50 ,75% of billed charges for outpatient setting,$502.98 ,83% of billed charges for outpatient setting,$303.00 ,50% of billed charges for outpatient setting,$303.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$237.35 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,$502.98 ,$303.00 Outpatient Medical Services,EMERGENCY,26605,APPLY SPLINT SHORT LEG,450,$603.00 ,$422.10 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$231.55 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$231.55 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$422.10 ,70% of billed charges for outpatient setting,$422.10 ,70% of billed charges for outpatient setting,$422.10 ,70% of billed charges for outpatient setting,$452.25 ,75% of billed charges for outpatient setting,$422.10 ,70% of billed charges for outpatient setting,$452.25 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.05 ,35% of billed charges for outpatient setting,$470.34 ,78% of billed charges for outpatient setting,$422.10 ,70% of billed charges for outpatient setting,$422.10 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$452.25 ,75% of billed charges for outpatient setting,$500.49 ,83% of billed charges for outpatient setting,$301.50 ,50% of billed charges for outpatient setting,$301.50 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$236.18 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,$500.49 ,$301.50 Outpatient Medical Services,EMERGENCY,26605,APPLY STRAP KNEE,450,$290.00 ,$203.00 ,70% of total billed charges for outpatient setting,$202.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$111.36 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$111.36 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$203.00 ,70% of billed charges for outpatient setting,$203.00 ,70% of billed charges for outpatient setting,$203.00 ,70% of billed charges for outpatient setting,$217.50 ,75% of billed charges for outpatient setting,$203.00 ,70% of billed charges for outpatient setting,$217.50 ,75% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.50 ,35% of billed charges for outpatient setting,$226.20 ,78% of billed charges for outpatient setting,$203.00 ,70% of billed charges for outpatient setting,$203.00 ,70% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$217.50 ,75% of billed charges for outpatient setting,$240.70 ,83% of billed charges for outpatient setting,$145.00 ,50% of billed charges for outpatient setting,$145.00 ,50% of billed charges for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.59 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$202.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.50 ,$240.70 ,$145.00 Outpatient Medical Services,EMERGENCY,96372,IM/SQ INJECTION ANY MED,450,$250.00 ,$175.00 ,70% of total billed charges for outpatient setting,$60.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$96.00 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$96.00 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$175.00 ,70% of billed charges for outpatient setting,$175.00 ,70% of billed charges for outpatient setting,$175.00 ,70% of billed charges for outpatient setting,$187.50 ,75% of billed charges for outpatient setting,$175.00 ,70% of billed charges for outpatient setting,$187.50 ,75% of billed charges for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.50 ,35% of billed charges for outpatient setting,$195.00 ,78% of billed charges for outpatient setting,$175.00 ,70% of billed charges for outpatient setting,$175.00 ,70% of billed charges for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.50 ,75% of billed charges for outpatient setting,$207.50 ,83% of billed charges for outpatient setting,$125.00 ,50% of billed charges for outpatient setting,$125.00 ,50% of billed charges for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.92 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$60.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.51 ,$207.50 ,$125.00 Outpatient Medical Services,EMERGENCY,99281,E.R.EM LEVEL 1,450,$443.00 ,$310.10 ,70% of total billed charges for outpatient setting,$76.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$50.00 ,100% ER case rate for outpatient setting,$50.00 ,100% ER case rate for outpatient setting,$310.10 ,100% Anthem fee schedule for outpatient setting,$310.10 ,100% Anthem fee schedule for outpatient setting,$310.10 ,100% Anthem fee schedule for outpatient setting,$332.25 ,100% Anthem fee schedule for outpatient setting,$310.10 ,100% Anthem fee schedule for outpatient setting,$332.25 ,100% Anthem fee schedule for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.00 ,105% ER case rate for outpatient setting,$345.54 ,78% of billed charges for outpatient setting,$310.10 ,70% of billed charges for outpatient setting,$310.10 ,70% of billed charges for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$332.25 ,75% of billed charges for outpatient setting,$367.69 ,83% of billed charges for outpatient setting,$221.50 ,50% of billed charges for outpatient setting,$221.50 ,50% of billed charges for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,102% ER case rate for outpatient setting,$76.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.00 ,$367.69 ,$221.50 Outpatient Medical Services,EMERGENCY,99282,E.R.EM LEVEL-2,450,$530.00 ,$371.00 ,70% of total billed charges for outpatient setting,$140.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$203.52 ,100% ER case rate for outpatient setting,$203.52 ,100% ER case rate for outpatient setting,$371.00 ,100% Anthem fee schedule for outpatient setting,$371.00 ,100% Anthem fee schedule for outpatient setting,$371.00 ,100% Anthem fee schedule for outpatient setting,$397.50 ,100% Anthem fee schedule for outpatient setting,$371.00 ,100% Anthem fee schedule for outpatient setting,$397.50 ,100% Anthem fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.50 ,105% ER case rate for outpatient setting,$413.40 ,78% of billed charges for outpatient setting,$371.00 ,70% of billed charges for outpatient setting,$371.00 ,70% of billed charges for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$397.50 ,75% of billed charges for outpatient setting,$439.90 ,83% of billed charges for outpatient setting,$265.00 ,50% of billed charges for outpatient setting,$265.00 ,50% of billed charges for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$207.59 ,102% ER case rate for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.47 ,$439.90 ,$265.00 Outpatient Medical Services,EMERGENCY,99283,E.R.EM LEVEL-3,450,$720.00 ,$504.00 ,70% of total billed charges for outpatient setting,$245.08 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$276.48 ,100% ER case rate for outpatient setting,$276.48 ,100% ER case rate for outpatient setting,$504.00 ,100% Anthem fee schedule for outpatient setting,$504.00 ,100% Anthem fee schedule for outpatient setting,$504.00 ,100% Anthem fee schedule for outpatient setting,$540.00 ,100% Anthem fee schedule for outpatient setting,$504.00 ,100% Anthem fee schedule for outpatient setting,$540.00 ,100% Anthem fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.00 ,105% ER case rate for outpatient setting,$561.60 ,78% of billed charges for outpatient setting,$504.00 ,70% of billed charges for outpatient setting,$504.00 ,70% of billed charges for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$540.00 ,75% of billed charges for outpatient setting,$597.60 ,83% of billed charges for outpatient setting,$360.00 ,50% of billed charges for outpatient setting,$360.00 ,50% of billed charges for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$282.01 ,102% ER case rate for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,$597.60 ,$360.00 Outpatient Medical Services,EMERGENCY,99284,E.R.EM LEVEL 4,450,$973.00 ,$681.10 ,70% of total billed charges for outpatient setting,$380.44 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$373.63 ,100% ER case rate for outpatient setting,$373.63 ,100% ER case rate for outpatient setting,$681.10 ,100% Anthem fee schedule for outpatient setting,$681.10 ,100% Anthem fee schedule for outpatient setting,$681.10 ,100% Anthem fee schedule for outpatient setting,$729.75 ,100% Anthem fee schedule for outpatient setting,$681.10 ,100% Anthem fee schedule for outpatient setting,$729.75 ,100% Anthem fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$340.55 ,105% ER case rate for outpatient setting,$758.94 ,78% of billed charges for outpatient setting,$681.10 ,70% of billed charges for outpatient setting,$681.10 ,70% of billed charges for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$729.75 ,75% of billed charges for outpatient setting,$807.59 ,83% of billed charges for outpatient setting,$486.50 ,50% of billed charges for outpatient setting,$486.50 ,50% of billed charges for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$381.10 ,102% ER case rate for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$340.55 ,$807.59 ,$486.50 Outpatient Medical Services,EMERGENCY,99291,ER CRITICAL CARE,450,"$1,248.00 ",$873.60 ,70% of total billed charges for outpatient setting,$762.23 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$479.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$479.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$873.60 ,100% Anthem fee schedule for outpatient setting,$873.60 ,100% Anthem fee schedule for outpatient setting,$873.60 ,100% Anthem fee schedule for outpatient setting,$936.00 ,100% Anthem fee schedule for outpatient setting,$873.60 ,100% Anthem fee schedule for outpatient setting,$936.00 ,100% Anthem fee schedule for outpatient setting,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$436.80 ,35% of billed charges for outpatient setting,$973.44 ,78% of billed charges for outpatient setting,$873.60 ,70% of billed charges for outpatient setting,$873.60 ,70% of billed charges for outpatient setting,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$936.00 ,75% of billed charges for outpatient setting,"$1,035.84 ",83% of billed charges for outpatient setting,$624.00 ,50% of billed charges for outpatient setting,$624.00 ,50% of billed charges for outpatient setting,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$488.81 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$762.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$436.80 ,"$1,035.84 ",$624.00 Outpatient Medical Services,EMERGENCY,99282,E.R.EM LEVEL-2 WITH 25 MODIFIER,450,$389.00 ,$272.30 ,70% of total billed charges for outpatient setting,$140.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$149.38 ,100% ER case rate for outpatient setting,$149.38 ,100% ER case rate for outpatient setting,$272.30 ,100% Anthem fee schedule for outpatient setting,$272.30 ,100% Anthem fee schedule for outpatient setting,$272.30 ,100% Anthem fee schedule for outpatient setting,$291.75 ,100% Anthem fee schedule for outpatient setting,$272.30 ,100% Anthem fee schedule for outpatient setting,$291.75 ,100% Anthem fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$136.15 ,105% ER case rate for outpatient setting,$303.42 ,78% of billed charges for outpatient setting,$272.30 ,70% of billed charges for outpatient setting,$272.30 ,70% of billed charges for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$291.75 ,75% of billed charges for outpatient setting,$322.87 ,83% of billed charges for outpatient setting,$194.50 ,50% of billed charges for outpatient setting,$194.50 ,50% of billed charges for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$152.37 ,102% ER case rate for outpatient setting,$140.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$136.15 ,$322.87 ,$194.50 Outpatient Medical Services,EMERGENCY,99283,E.R.EM LEVEL-3 WITH 25 MODIFIER,450,$766.00 ,$536.20 ,70% of total billed charges for outpatient setting,$245.08 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$294.14 ,100% ER case rate for outpatient setting,$294.14 ,100% ER case rate for outpatient setting,$536.20 ,100% Anthem fee schedule for outpatient setting,$536.20 ,100% Anthem fee schedule for outpatient setting,$536.20 ,100% Anthem fee schedule for outpatient setting,$574.50 ,100% Anthem fee schedule for outpatient setting,$536.20 ,100% Anthem fee schedule for outpatient setting,$574.50 ,100% Anthem fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$268.10 ,105% ER case rate for outpatient setting,$597.48 ,78% of billed charges for outpatient setting,$536.20 ,70% of billed charges for outpatient setting,$536.20 ,70% of billed charges for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$574.50 ,75% of billed charges for outpatient setting,$635.78 ,83% of billed charges for outpatient setting,$383.00 ,50% of billed charges for outpatient setting,$383.00 ,50% of billed charges for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$300.02 ,102% ER case rate for outpatient setting,$245.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$245.08 ,$635.78 ,$383.00 Outpatient Medical Services,EMERGENCY,99284,E.R.EM LEVEL 4 WITH 25 MODIFIER,450,"$1,067.00 ",$746.90 ,70% of total billed charges for outpatient setting,$380.44 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$409.73 ,100% ER case rate for outpatient setting,$409.73 ,100% ER case rate for outpatient setting,$746.90 ,100% Anthem fee schedule for outpatient setting,$746.90 ,100% Anthem fee schedule for outpatient setting,$746.90 ,100% Anthem fee schedule for outpatient setting,$800.25 ,100% Anthem fee schedule for outpatient setting,$746.90 ,100% Anthem fee schedule for outpatient setting,$800.25 ,100% Anthem fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$373.45 ,105% ER case rate for outpatient setting,$832.26 ,78% of billed charges for outpatient setting,$746.90 ,70% of billed charges for outpatient setting,$746.90 ,70% of billed charges for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$800.25 ,75% of billed charges for outpatient setting,$885.61 ,83% of billed charges for outpatient setting,$533.50 ,50% of billed charges for outpatient setting,$533.50 ,50% of billed charges for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$417.92 ,102% ER case rate for outpatient setting,$380.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$373.45 ,$885.61 ,$533.50 Outpatient Medical Services,EMERGENCY,99285,E.R.EM LEVEL 5 WITH 25 MODIFIER,450,"$1,542.00 ","$1,079.40 ",70% of total billed charges for outpatient setting,$551.73 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$592.13 ,100% ER case rate for outpatient setting,$592.13 ,100% ER case rate for outpatient setting,"$1,079.40 ",100% Anthem fee schedule for outpatient setting,"$1,079.40 ",100% Anthem fee schedule for outpatient setting,"$1,079.40 ",100% Anthem fee schedule for outpatient setting,"$1,156.50 ",100% Anthem fee schedule for outpatient setting,"$1,079.40 ",100% Anthem fee schedule for outpatient setting,"$1,156.50 ",100% Anthem fee schedule for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$539.70 ,105% ER case rate for outpatient setting,"$1,202.76 ",78% of billed charges for outpatient setting,"$1,079.40 ",70% of billed charges for outpatient setting,"$1,079.40 ",70% of billed charges for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,156.50 ",75% of billed charges for outpatient setting,"$1,279.86 ",83% of billed charges for outpatient setting,$771.00 ,50% of billed charges for outpatient setting,$771.00 ,50% of billed charges for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$603.97 ,102% ER case rate for outpatient setting,$551.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$539.70 ,"$1,279.86 ",$771.00 Outpatient Medical Services,LAB,J2920,METHYLPREDNISOLONE(SOLU-MEDROL) 40MG/1ml,250,$15.00 ,$10.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.19 ,100% GA Medicaid fee schedule for outpatient setting,$4.19 ,100% GA Medicaid fee schedule for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,$11.25 ,75% of billed charges for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,$11.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.40 ,105% GA Medicaid fee schedule for outpatient setting,$11.70 ,78% of billed charges for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,$10.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$11.25 ,75% of billed charges for outpatient setting,$12.45 ,83% of billed charges for outpatient setting,$7.50 ,50% of billed charges for outpatient setting,$7.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.27 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.19 ,$12.45 ,$7.50 Outpatient Medical Services,LAB,80299,APIXABAN (ELIQUIS) 5 MG TABLET,250,$16.00 ,$11.20 ,70% of total billed charges for outpatient setting,$18.64 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$15.14 ,100% GA Medicaid fee schedule for outpatient setting,$15.14 ,100% GA Medicaid fee schedule for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.90 ,105% GA Medicaid fee schedule for outpatient setting,$12.48 ,78% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$13.28 ,83% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.44 ,102% GA Medicaid fee schedule for outpatient setting,$18.64 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.00 ,$18.64 ,$8.00 Outpatient Medical Services,LAB,C9113,PANTOPRAZOLE (PROTONIX) 40 MG TABLET,250,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.75 ,35% of billed charges for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.96 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$1.75 ,$4.15 ,$2.50 Outpatient Medical Services,LAB,94664,ALBUTEROL / IPRATROP(DUONEB) 0.5/3MG 3ML,250,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,$183.21 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.75 ,35% of billed charges for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.96 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.75 ,$183.21 ,$2.50 Outpatient Medical Services,LAB,J1644,HEPARIN 5000 UNITS vial,250,$6.00 ,$4.20 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.27 ,100% GA Medicaid fee schedule for outpatient setting,$0.27 ,100% GA Medicaid fee schedule for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,$4.50 ,75% of billed charges for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,$4.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.28 ,105% GA Medicaid fee schedule for outpatient setting,$4.68 ,78% of billed charges for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,$4.20 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.50 ,75% of billed charges for outpatient setting,$4.98 ,83% of billed charges for outpatient setting,$3.00 ,50% of billed charges for outpatient setting,$3.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.28 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.27 ,$4.98 ,$3.00 Outpatient Medical Services,LAB,96360,SODIUM CHLORIDE 0.9% 1BAG 1000ML,258,$7.00 ,$4.90 ,70% of total billed charges for outpatient setting,$184.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$2.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$2.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.45 ,35% of billed charges for outpatient setting,$5.46 ,78% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,$5.81 ,83% of billed charges for outpatient setting,$3.50 ,50% of billed charges for outpatient setting,$3.50 ,50% of billed charges for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.74 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$184.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.45 ,$184.11 ,$3.50 Outpatient Medical Services,LAB,J7030,NORMAL SALINE 100ML + ADAPTER,258,$10.00 ,$7.00 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$2.69 ,100% GA Medicaid fee schedule for outpatient setting,$2.69 ,100% GA Medicaid fee schedule for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,$7.50 ,75% of billed charges for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,$7.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$2.82 ,105% GA Medicaid fee schedule for outpatient setting,$7.80 ,78% of billed charges for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,$7.00 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$7.50 ,75% of billed charges for outpatient setting,$8.30 ,83% of billed charges for outpatient setting,$5.00 ,50% of billed charges for outpatient setting,$5.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$2.74 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$2.69 ,$8.30 ,$5.00 Outpatient Medical Services,LAB,96375,ADDITIONAL IV PUSH NEW MED,260,$236.00 ,$165.20 ,70% of total billed charges for outpatient setting,$40.79 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$90.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$90.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$165.20 ,70% of billed charges for outpatient setting,$165.20 ,70% of billed charges for outpatient setting,$165.20 ,70% of billed charges for outpatient setting,$177.00 ,75% of billed charges for outpatient setting,$165.20 ,70% of billed charges for outpatient setting,$177.00 ,75% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.60 ,35% of billed charges for outpatient setting,$184.08 ,78% of billed charges for outpatient setting,$165.20 ,70% of billed charges for outpatient setting,$165.20 ,70% of billed charges for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.00 ,75% of billed charges for outpatient setting,$195.88 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.43 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$40.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.79 ,$212.00 ,$118.00 Outpatient Medical Services,LAB,36415,VENIPUNCTURE,300,$21.00 ,$14.70 ,70% of total billed charges for outpatient setting,$8.83 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$8.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.35 ,35% of billed charges for outpatient setting,$16.38 ,78% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$17.43 ,83% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.22 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.35 ,$17.43 ,$10.50 Outpatient Medical Services,LAB,36415,VENIPUNCTURE,300,$21.00 ,$14.70 ,70% of total billed charges for outpatient setting,$8.83 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$8.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.35 ,35% of billed charges for outpatient setting,$16.38 ,78% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$17.43 ,83% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.22 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.35 ,$17.43 ,$10.50 Outpatient Medical Services,LAB,36415,COLLECTION FEE - DRUG SCREEN,300,$25.00 ,$17.50 ,70% of total billed charges for outpatient setting,$8.83 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$9.60 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$9.60 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$17.50 ,70% of billed charges for outpatient setting,$17.50 ,70% of billed charges for outpatient setting,$17.50 ,70% of billed charges for outpatient setting,$18.75 ,75% of billed charges for outpatient setting,$17.50 ,70% of billed charges for outpatient setting,$18.75 ,75% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.75 ,35% of billed charges for outpatient setting,$19.50 ,78% of billed charges for outpatient setting,$17.50 ,70% of billed charges for outpatient setting,$17.50 ,70% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.75 ,75% of billed charges for outpatient setting,$20.75 ,83% of billed charges for outpatient setting,$12.50 ,50% of billed charges for outpatient setting,$12.50 ,50% of billed charges for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.79 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$8.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.75 ,$20.75 ,$12.50 Outpatient Medical Services,LAB,80048,BASIC METAB,300,$58.00 ,$40.60 ,70% of total billed charges for outpatient setting,$8.46 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.18 ,105% GA Medicaid fee schedule for outpatient setting,$45.24 ,78% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$43.50 ,75% of billed charges for outpatient setting,$48.14 ,83% of billed charges for outpatient setting,$29.00 ,50% of billed charges for outpatient setting,$29.00 ,50% of billed charges for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.86 ,102% GA Medicaid fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,$48.14 ,$29.00 Outpatient Medical Services,LAB,80048,BASIC METAB,300,$57.00 ,$39.90 ,70% of total billed charges for outpatient setting,$8.46 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$10.44 ,100% Anthem fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.18 ,105% GA Medicaid fee schedule for outpatient setting,$44.46 ,78% of billed charges for outpatient setting,$39.90 ,70% of billed charges for outpatient setting,$39.90 ,70% of billed charges for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.75 ,75% of billed charges for outpatient setting,$47.31 ,83% of billed charges for outpatient setting,$28.50 ,50% of billed charges for outpatient setting,$28.50 ,50% of billed charges for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.86 ,102% GA Medicaid fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,$47.31 ,$28.50 Outpatient Medical Services,LAB,80053,COMPREHENSI,300,$79.00 ,$55.30 ,70% of total billed charges for outpatient setting,$10.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$59.25 ,75% of billed charges for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$59.25 ,75% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.95 ,105% GA Medicaid fee schedule for outpatient setting,$61.62 ,78% of billed charges for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$55.30 ,70% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.25 ,75% of billed charges for outpatient setting,$65.57 ,83% of billed charges for outpatient setting,$39.50 ,50% of billed charges for outpatient setting,$39.50 ,50% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.56 ,102% GA Medicaid fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,$65.57 ,$39.50 Outpatient Medical Services,LAB,80053,COMPREHENSIVE PANEL,300,$150.00 ,$105.00 ,70% of total billed charges for outpatient setting,$10.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$112.50 ,75% of billed charges for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$112.50 ,75% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.95 ,105% GA Medicaid fee schedule for outpatient setting,$117.00 ,78% of billed charges for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$105.00 ,70% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$112.50 ,75% of billed charges for outpatient setting,$124.50 ,83% of billed charges for outpatient setting,$75.00 ,50% of billed charges for outpatient setting,$75.00 ,50% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.56 ,102% GA Medicaid fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,$124.50 ,$75.00 Outpatient Medical Services,LAB,80053,COMPREHENSIVE PANEL,300,$152.00 ,$106.40 ,70% of total billed charges for outpatient setting,$10.56 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$114.00 ,75% of billed charges for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$114.00 ,75% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.95 ,105% GA Medicaid fee schedule for outpatient setting,$118.56 ,78% of billed charges for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$106.40 ,70% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$114.00 ,75% of billed charges for outpatient setting,$126.16 ,83% of billed charges for outpatient setting,$76.00 ,50% of billed charges for outpatient setting,$76.00 ,50% of billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.56 ,102% GA Medicaid fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,$126.16 ,$76.00 Outpatient Medical Services,LAB,80061,LIPID PROFILE,300,$235.00 ,$164.50 ,70% of total billed charges for outpatient setting,$13.39 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.69 ,105% GA Medicaid fee schedule for outpatient setting,$183.30 ,78% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$164.50 ,70% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$176.25 ,75% of billed charges for outpatient setting,$195.05 ,83% of billed charges for outpatient setting,$117.50 ,50% of billed charges for outpatient setting,$117.50 ,50% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.19 ,102% GA Medicaid fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,$195.05 ,$117.50 Outpatient Medical Services,LAB,80061,LIPID PROFILE,300,$233.00 ,$163.10 ,70% of total billed charges for outpatient setting,$13.39 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$174.75 ,75% of billed charges for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$174.75 ,75% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.69 ,105% GA Medicaid fee schedule for outpatient setting,$181.74 ,78% of billed charges for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$163.10 ,70% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.75 ,75% of billed charges for outpatient setting,$193.39 ,83% of billed charges for outpatient setting,$116.50 ,50% of billed charges for outpatient setting,$116.50 ,50% of billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.19 ,102% GA Medicaid fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,$193.39 ,$116.50 Outpatient Medical Services,LAB,80074,HEPATITIS PANEL,300,$179.00 ,$125.30 ,70% of total billed charges for outpatient setting,$47.63 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$59.89 ,100% GA Medicaid fee schedule for outpatient setting,$59.89 ,100% GA Medicaid fee schedule for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$134.25 ,75% of billed charges for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$134.25 ,75% of billed charges for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$62.88 ,105% GA Medicaid fee schedule for outpatient setting,$139.62 ,78% of billed charges for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$125.30 ,70% of billed charges for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.25 ,75% of billed charges for outpatient setting,$148.57 ,83% of billed charges for outpatient setting,$89.50 ,50% of billed charges for outpatient setting,$89.50 ,50% of billed charges for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.09 ,102% GA Medicaid fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.63 ,$148.57 ,$89.50 Outpatient Medical Services,LAB,80076,LIVER FUNCTION PANEL,300,$27.00 ,$18.90 ,70% of total billed charges for outpatient setting,$8.17 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$20.25 ,75% of billed charges for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$20.25 ,75% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.79 ,105% GA Medicaid fee schedule for outpatient setting,$21.06 ,78% of billed charges for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$18.90 ,70% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.25 ,75% of billed charges for outpatient setting,$22.41 ,83% of billed charges for outpatient setting,$13.50 ,50% of billed charges for outpatient setting,$13.50 ,50% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.49 ,102% GA Medicaid fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,$22.41 ,$13.50 Outpatient Medical Services,LAB,80076,LIVER FUNCTION PANEL,300,$28.00 ,$19.60 ,70% of total billed charges for outpatient setting,$8.17 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.79 ,105% GA Medicaid fee schedule for outpatient setting,$21.84 ,78% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$23.24 ,83% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.49 ,102% GA Medicaid fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,$23.24 ,$14.00 Outpatient Medical Services,LAB,80307,SAP 10 DRUG SCREEN,300,$252.00 ,$176.40 ,70% of total billed charges for outpatient setting,$62.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$189.00 ,75% of billed charges for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$189.00 ,75% of billed charges for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.22 ,105% GA Medicaid fee schedule for outpatient setting,$196.56 ,78% of billed charges for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$176.40 ,70% of billed charges for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$189.00 ,75% of billed charges for outpatient setting,$209.16 ,83% of billed charges for outpatient setting,$126.00 ,50% of billed charges for outpatient setting,$126.00 ,50% of billed charges for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$62.38 ,102% GA Medicaid fee schedule for outpatient setting,$62.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.16 ,$209.16 ,$126.00 Outpatient Medical Services,LAB,80320,ALCOHOL,300,$38.00 ,$26.60 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$13.59 ,100% GA Medicaid fee schedule for outpatient setting,$13.59 ,100% GA Medicaid fee schedule for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,$28.50 ,75% of billed charges for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,$28.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$14.27 ,105% GA Medicaid fee schedule for outpatient setting,$29.64 ,78% of billed charges for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,$26.60 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$28.50 ,75% of billed charges for outpatient setting,$31.54 ,83% of billed charges for outpatient setting,$19.00 ,50% of billed charges for outpatient setting,$19.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$13.86 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$13.59 ,$31.54 ,$19.00 Outpatient Medical Services,LAB,81001,CHARGE FOR URINE W/MICRO,300,$64.00 ,$44.80 ,70% of total billed charges for outpatient setting,$3.17 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.19 ,105% GA Medicaid fee schedule for outpatient setting,$49.92 ,78% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,75% of billed charges for outpatient setting,$53.12 ,83% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.07 ,102% GA Medicaid fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,$53.12 ,$32.00 Outpatient Medical Services,LAB,81001,CHARGE FOR URINE W/MICRO,300,$64.00 ,$44.80 ,70% of total billed charges for outpatient setting,$3.17 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.92 ,100% Anthem fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.19 ,105% GA Medicaid fee schedule for outpatient setting,$49.92 ,78% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,75% of billed charges for outpatient setting,$53.12 ,83% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.07 ,102% GA Medicaid fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,$53.12 ,$32.00 Outpatient Medical Services,LAB,81003,CHARGE FOR UA W/O MICRO,300,$41.00 ,$28.70 ,70% of total billed charges for outpatient setting,$2.25 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.97 ,105% GA Medicaid fee schedule for outpatient setting,$31.98 ,78% of billed charges for outpatient setting,$28.70 ,70% of billed charges for outpatient setting,$28.70 ,70% of billed charges for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.75 ,75% of billed charges for outpatient setting,$34.03 ,83% of billed charges for outpatient setting,$20.50 ,50% of billed charges for outpatient setting,$20.50 ,50% of billed charges for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.89 ,102% GA Medicaid fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,$34.03 ,$20.50 Outpatient Medical Services,LAB,81003,CHARGE FOR UA W/O MICRO,300,$42.00 ,$29.40 ,70% of total billed charges for outpatient setting,$2.25 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.77 ,100% Anthem fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.97 ,105% GA Medicaid fee schedule for outpatient setting,$32.76 ,78% of billed charges for outpatient setting,$29.40 ,70% of billed charges for outpatient setting,$29.40 ,70% of billed charges for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.50 ,75% of billed charges for outpatient setting,$34.86 ,83% of billed charges for outpatient setting,$21.00 ,50% of billed charges for outpatient setting,$21.00 ,50% of billed charges for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.89 ,102% GA Medicaid fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,$34.86 ,$21.00 Outpatient Medical Services,LAB,81025,HCG URINE,300,$134.00 ,$93.80 ,70% of total billed charges for outpatient setting,$8.61 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.36 ,105% GA Medicaid fee schedule for outpatient setting,$104.52 ,78% of billed charges for outpatient setting,$93.80 ,70% of billed charges for outpatient setting,$93.80 ,70% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$100.50 ,75% of billed charges for outpatient setting,$111.22 ,83% of billed charges for outpatient setting,$67.00 ,50% of billed charges for outpatient setting,$67.00 ,50% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.12 ,102% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.96 ,$111.22 ,$67.00 Outpatient Medical Services,LAB,81025,HCG URINE,300,$149.00 ,$104.30 ,70% of total billed charges for outpatient setting,$8.61 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% Anthem fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.36 ,105% GA Medicaid fee schedule for outpatient setting,$116.22 ,78% of billed charges for outpatient setting,$104.30 ,70% of billed charges for outpatient setting,$104.30 ,70% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$111.75 ,75% of billed charges for outpatient setting,$123.67 ,83% of billed charges for outpatient setting,$74.50 ,50% of billed charges for outpatient setting,$74.50 ,50% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.12 ,102% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.96 ,$123.67 ,$74.50 Outpatient Medical Services,LAB,82009,ACETONE QUAL,300,$49.00 ,$34.30 ,70% of total billed charges for outpatient setting,$4.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.13 ,100% GA Medicaid fee schedule for outpatient setting,$4.13 ,100% GA Medicaid fee schedule for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.34 ,105% GA Medicaid fee schedule for outpatient setting,$38.22 ,78% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$40.67 ,83% of billed charges for outpatient setting,$24.50 ,50% of billed charges for outpatient setting,$24.50 ,50% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.21 ,102% GA Medicaid fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.13 ,$40.67 ,$24.50 Outpatient Medical Services,LAB,82043,MICROALBUMIN URINE,300,$24.00 ,$16.80 ,70% of total billed charges for outpatient setting,$5.78 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.28 ,100% GA Medicaid fee schedule for outpatient setting,$7.28 ,100% GA Medicaid fee schedule for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$18.00 ,75% of billed charges for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$18.00 ,75% of billed charges for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.64 ,105% GA Medicaid fee schedule for outpatient setting,$18.72 ,78% of billed charges for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$16.80 ,70% of billed charges for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.00 ,75% of billed charges for outpatient setting,$19.92 ,83% of billed charges for outpatient setting,$12.00 ,50% of billed charges for outpatient setting,$12.00 ,50% of billed charges for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.43 ,102% GA Medicaid fee schedule for outpatient setting,$5.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.78 ,$19.92 ,$12.00 Outpatient Medical Services,LAB,82140,AMMONIA,300,$33.00 ,$23.10 ,70% of total billed charges for outpatient setting,$14.57 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.44 ,100% GA Medicaid fee schedule for outpatient setting,$12.44 ,100% GA Medicaid fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$17.99 ,100% Anthem fee schedule for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.06 ,105% GA Medicaid fee schedule for outpatient setting,$25.74 ,78% of billed charges for outpatient setting,$23.10 ,70% of billed charges for outpatient setting,$23.10 ,70% of billed charges for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.75 ,75% of billed charges for outpatient setting,$27.39 ,83% of billed charges for outpatient setting,$16.50 ,50% of billed charges for outpatient setting,$16.50 ,50% of billed charges for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.69 ,102% GA Medicaid fee schedule for outpatient setting,$14.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.44 ,$27.39 ,$16.50 Outpatient Medical Services,LAB,82150,AMYLASE,300,$45.00 ,$31.50 ,70% of total billed charges for outpatient setting,$6.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$8.00 ,100% Anthem fee schedule for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.56 ,105% GA Medicaid fee schedule for outpatient setting,$35.10 ,78% of billed charges for outpatient setting,$31.50 ,70% of billed charges for outpatient setting,$31.50 ,70% of billed charges for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.75 ,75% of billed charges for outpatient setting,$37.35 ,83% of billed charges for outpatient setting,$22.50 ,50% of billed charges for outpatient setting,$22.50 ,50% of billed charges for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.31 ,102% GA Medicaid fee schedule for outpatient setting,$6.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,$37.35 ,$22.50 Outpatient Medical Services,LAB,82248,DIRECT BILIRUBIN,300,$106.00 ,$74.20 ,70% of total billed charges for outpatient setting,$5.01 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$6.19 ,100% Anthem fee schedule for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.64 ,105% GA Medicaid fee schedule for outpatient setting,$82.68 ,78% of billed charges for outpatient setting,$74.20 ,70% of billed charges for outpatient setting,$74.20 ,70% of billed charges for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.50 ,75% of billed charges for outpatient setting,$87.98 ,83% of billed charges for outpatient setting,$53.00 ,50% of billed charges for outpatient setting,$53.00 ,50% of billed charges for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.45 ,102% GA Medicaid fee schedule for outpatient setting,$5.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.01 ,$87.98 ,$53.00 Outpatient Medical Services,LAB,82306,VITAMIN D 25 HYDROXY,300,$105.00 ,$73.50 ,70% of total billed charges for outpatient setting,$29.60 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$78.75 ,75% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$78.75 ,75% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.08 ,105% GA Medicaid fee schedule for outpatient setting,$81.90 ,78% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.75 ,75% of billed charges for outpatient setting,$87.15 ,83% of billed charges for outpatient setting,$52.50 ,50% of billed charges for outpatient setting,$52.50 ,50% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.96 ,102% GA Medicaid fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,$87.15 ,$52.50 Outpatient Medical Services,LAB,82306,VITAMIN D 25 HYDROXY,300,$101.00 ,$70.70 ,70% of total billed charges for outpatient setting,$29.60 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$75.75 ,75% of billed charges for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$75.75 ,75% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.08 ,105% GA Medicaid fee schedule for outpatient setting,$78.78 ,78% of billed charges for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$70.70 ,70% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.75 ,75% of billed charges for outpatient setting,$83.83 ,83% of billed charges for outpatient setting,$50.50 ,50% of billed charges for outpatient setting,$50.50 ,50% of billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.96 ,102% GA Medicaid fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,$83.83 ,$50.50 Outpatient Medical Services,LAB,82550,CPK TOTAL,300,$26.00 ,$18.20 ,70% of total billed charges for outpatient setting,$6.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.67 ,105% GA Medicaid fee schedule for outpatient setting,$20.28 ,78% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$21.58 ,83% of billed charges for outpatient setting,$13.00 ,50% of billed charges for outpatient setting,$13.00 ,50% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,102% GA Medicaid fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.35 ,$21.58 ,$13.00 Outpatient Medical Services,LAB,82550,CPK TOTAL,300,$26.00 ,$18.20 ,70% of total billed charges for outpatient setting,$6.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.67 ,105% GA Medicaid fee schedule for outpatient setting,$20.28 ,78% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$18.20 ,70% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.50 ,75% of billed charges for outpatient setting,$21.58 ,83% of billed charges for outpatient setting,$13.00 ,50% of billed charges for outpatient setting,$13.00 ,50% of billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,102% GA Medicaid fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.35 ,$21.58 ,$13.00 Outpatient Medical Services,LAB,82565,CREATININE,300,$112.00 ,$78.40 ,70% of total billed charges for outpatient setting,$5.12 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$6.33 ,100% Anthem fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.67 ,105% GA Medicaid fee schedule for outpatient setting,$87.36 ,78% of billed charges for outpatient setting,$78.40 ,70% of billed charges for outpatient setting,$78.40 ,70% of billed charges for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.00 ,75% of billed charges for outpatient setting,$92.96 ,83% of billed charges for outpatient setting,$56.00 ,50% of billed charges for outpatient setting,$56.00 ,50% of billed charges for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.48 ,102% GA Medicaid fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.12 ,$92.96 ,$56.00 Outpatient Medical Services,LAB,82570,URINE CREATININE,300,$43.00 ,$30.10 ,70% of total billed charges for outpatient setting,$5.18 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$32.25 ,75% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$32.25 ,75% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.84 ,105% GA Medicaid fee schedule for outpatient setting,$33.54 ,78% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.25 ,75% of billed charges for outpatient setting,$35.69 ,83% of billed charges for outpatient setting,$21.50 ,50% of billed charges for outpatient setting,$21.50 ,50% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.64 ,102% GA Medicaid fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,$35.69 ,$21.50 Outpatient Medical Services,LAB,82607,VIT B-12,300,$52.00 ,$36.40 ,70% of total billed charges for outpatient setting,$15.08 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.90 ,105% GA Medicaid fee schedule for outpatient setting,$40.56 ,78% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$43.16 ,83% of billed charges for outpatient setting,$26.00 ,50% of billed charges for outpatient setting,$26.00 ,50% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.33 ,102% GA Medicaid fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,$43.16 ,$26.00 Outpatient Medical Services,LAB,82607,VIT B-12,300,$52.00 ,$36.40 ,70% of total billed charges for outpatient setting,$15.08 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.90 ,105% GA Medicaid fee schedule for outpatient setting,$40.56 ,78% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$36.40 ,70% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.00 ,75% of billed charges for outpatient setting,$43.16 ,83% of billed charges for outpatient setting,$26.00 ,50% of billed charges for outpatient setting,$26.00 ,50% of billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.33 ,102% GA Medicaid fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,$43.16 ,$26.00 Outpatient Medical Services,LAB,82652,VITAMIN D,300,$397.00 ,$277.90 ,70% of total billed charges for outpatient setting,$38.50 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$48.40 ,100% GA Medicaid fee schedule for outpatient setting,$48.40 ,100% GA Medicaid fee schedule for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.82 ,105% GA Medicaid fee schedule for outpatient setting,$309.66 ,78% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$277.90 ,70% of billed charges for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$297.75 ,75% of billed charges for outpatient setting,$329.51 ,83% of billed charges for outpatient setting,$198.50 ,50% of billed charges for outpatient setting,$198.50 ,50% of billed charges for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.37 ,102% GA Medicaid fee schedule for outpatient setting,$38.50 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.50 ,$329.51 ,$198.50 Outpatient Medical Services,LAB,82728,FERRITIN LEVEL,300,$47.00 ,$32.90 ,70% of total billed charges for outpatient setting,$13.63 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$17.13 ,100% GA Medicaid fee schedule for outpatient setting,$17.13 ,100% GA Medicaid fee schedule for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$35.25 ,75% of billed charges for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$35.25 ,75% of billed charges for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.99 ,105% GA Medicaid fee schedule for outpatient setting,$36.66 ,78% of billed charges for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$32.90 ,70% of billed charges for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.25 ,75% of billed charges for outpatient setting,$39.01 ,83% of billed charges for outpatient setting,$23.50 ,50% of billed charges for outpatient setting,$23.50 ,50% of billed charges for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.47 ,102% GA Medicaid fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,$39.01 ,$23.50 Outpatient Medical Services,LAB,82746,FOLIC ACID,300,$51.00 ,$35.70 ,70% of total billed charges for outpatient setting,$14.70 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$18.49 ,100% GA Medicaid fee schedule for outpatient setting,$18.49 ,100% GA Medicaid fee schedule for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$38.25 ,75% of billed charges for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$38.25 ,75% of billed charges for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.41 ,105% GA Medicaid fee schedule for outpatient setting,$39.78 ,78% of billed charges for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$35.70 ,70% of billed charges for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.25 ,75% of billed charges for outpatient setting,$42.33 ,83% of billed charges for outpatient setting,$25.50 ,50% of billed charges for outpatient setting,$25.50 ,50% of billed charges for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.86 ,102% GA Medicaid fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.70 ,$42.33 ,$25.50 Outpatient Medical Services,LAB,83036,GLYCOHEMOGLOBIN,300,$34.00 ,$23.80 ,70% of total billed charges for outpatient setting,$9.71 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.81 ,105% GA Medicaid fee schedule for outpatient setting,$26.52 ,78% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.50 ,75% of billed charges for outpatient setting,$28.22 ,83% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.44 ,102% GA Medicaid fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,$28.22 ,$17.00 Outpatient Medical Services,LAB,83036,GLYCOHEMOGLOBIN,300,$34.00 ,$23.80 ,70% of total billed charges for outpatient setting,$9.71 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$11.99 ,100% Anthem fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.81 ,105% GA Medicaid fee schedule for outpatient setting,$26.52 ,78% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.50 ,75% of billed charges for outpatient setting,$28.22 ,83% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.44 ,102% GA Medicaid fee schedule for outpatient setting,$9.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.71 ,$28.22 ,$17.00 Outpatient Medical Services,LAB,83550,I & IBC (B),300,$30.00 ,$21.00 ,70% of total billed charges for outpatient setting,$8.74 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.99 ,100% GA Medicaid fee schedule for outpatient setting,$10.99 ,100% GA Medicaid fee schedule for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$22.50 ,75% of billed charges for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$22.50 ,75% of billed charges for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.54 ,105% GA Medicaid fee schedule for outpatient setting,$23.40 ,78% of billed charges for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$21.00 ,70% of billed charges for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.50 ,75% of billed charges for outpatient setting,$24.90 ,83% of billed charges for outpatient setting,$15.00 ,50% of billed charges for outpatient setting,$15.00 ,50% of billed charges for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.21 ,102% GA Medicaid fee schedule for outpatient setting,$8.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.74 ,$24.90 ,$15.00 Outpatient Medical Services,LAB,83605,LACTIC ACID,300,$37.00 ,$25.90 ,70% of total billed charges for outpatient setting,$11.57 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$13.43 ,100% GA Medicaid fee schedule for outpatient setting,$13.43 ,100% GA Medicaid fee schedule for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.10 ,105% GA Medicaid fee schedule for outpatient setting,$28.86 ,78% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$25.90 ,70% of billed charges for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.75 ,75% of billed charges for outpatient setting,$30.71 ,83% of billed charges for outpatient setting,$18.50 ,50% of billed charges for outpatient setting,$18.50 ,50% of billed charges for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.70 ,102% GA Medicaid fee schedule for outpatient setting,$11.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.57 ,$30.71 ,$18.50 Outpatient Medical Services,LAB,83655,LEAD,300,$126.00 ,$88.20 ,70% of total billed charges for outpatient setting,$12.11 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$94.50 ,75% of billed charges for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$94.50 ,75% of billed charges for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.50 ,105% GA Medicaid fee schedule for outpatient setting,$98.28 ,78% of billed charges for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$88.20 ,70% of billed charges for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.50 ,75% of billed charges for outpatient setting,$104.58 ,83% of billed charges for outpatient setting,$63.00 ,50% of billed charges for outpatient setting,$63.00 ,50% of billed charges for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.20 ,102% GA Medicaid fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.00 ,$104.58 ,$63.00 Outpatient Medical Services,LAB,83690,LIPASE,300,$138.00 ,$96.60 ,70% of total billed charges for outpatient setting,$6.89 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.66 ,100% GA Medicaid fee schedule for outpatient setting,$8.66 ,100% GA Medicaid fee schedule for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$103.50 ,75% of billed charges for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$103.50 ,75% of billed charges for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.09 ,105% GA Medicaid fee schedule for outpatient setting,$107.64 ,78% of billed charges for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$96.60 ,70% of billed charges for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$103.50 ,75% of billed charges for outpatient setting,$114.54 ,83% of billed charges for outpatient setting,$69.00 ,50% of billed charges for outpatient setting,$69.00 ,50% of billed charges for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.83 ,102% GA Medicaid fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,$114.54 ,$69.00 Outpatient Medical Services,LAB,83735,MAGNESIUM,300,$23.00 ,$16.10 ,70% of total billed charges for outpatient setting,$6.70 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.84 ,105% GA Medicaid fee schedule for outpatient setting,$17.94 ,78% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$19.09 ,83% of billed charges for outpatient setting,$11.50 ,50% of billed charges for outpatient setting,$11.50 ,50% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.59 ,102% GA Medicaid fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,$19.09 ,$11.50 Outpatient Medical Services,LAB,83735,MAGNESIUM,300,$23.00 ,$16.10 ,70% of total billed charges for outpatient setting,$6.70 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.84 ,105% GA Medicaid fee schedule for outpatient setting,$17.94 ,78% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$16.10 ,70% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.25 ,75% of billed charges for outpatient setting,$19.09 ,83% of billed charges for outpatient setting,$11.50 ,50% of billed charges for outpatient setting,$11.50 ,50% of billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.59 ,102% GA Medicaid fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,$19.09 ,$11.50 Outpatient Medical Services,LAB,83880,BNP,300,$118.00 ,$82.60 ,70% of total billed charges for outpatient setting,$39.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$88.50 ,75% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$88.50 ,75% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.82 ,105% GA Medicaid fee schedule for outpatient setting,$92.04 ,78% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$88.50 ,75% of billed charges for outpatient setting,$97.94 ,83% of billed charges for outpatient setting,$59.00 ,50% of billed charges for outpatient setting,$59.00 ,50% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$43.54 ,102% GA Medicaid fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,$97.94 ,$59.00 Outpatient Medical Services,LAB,83880,BNP,300,$116.00 ,$81.20 ,70% of total billed charges for outpatient setting,$39.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.82 ,105% GA Medicaid fee schedule for outpatient setting,$90.48 ,78% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$81.20 ,70% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.00 ,75% of billed charges for outpatient setting,$96.28 ,83% of billed charges for outpatient setting,$58.00 ,50% of billed charges for outpatient setting,$58.00 ,50% of billed charges for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$43.54 ,102% GA Medicaid fee schedule for outpatient setting,$39.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.26 ,$96.28 ,$58.00 Outpatient Medical Services,LAB,83970,PTH - INTACT,300,$142.00 ,$99.40 ,70% of total billed charges for outpatient setting,$41.28 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$51.90 ,100% GA Medicaid fee schedule for outpatient setting,$51.90 ,100% GA Medicaid fee schedule for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$106.50 ,75% of billed charges for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$106.50 ,75% of billed charges for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$54.50 ,105% GA Medicaid fee schedule for outpatient setting,$110.76 ,78% of billed charges for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$99.40 ,70% of billed charges for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$106.50 ,75% of billed charges for outpatient setting,$117.86 ,83% of billed charges for outpatient setting,$71.00 ,50% of billed charges for outpatient setting,$71.00 ,50% of billed charges for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.94 ,102% GA Medicaid fee schedule for outpatient setting,$41.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.28 ,$117.86 ,$71.00 Outpatient Medical Services,LAB,84100,PHOSPHORUS,300,$17.00 ,$11.90 ,70% of total billed charges for outpatient setting,$4.74 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$12.75 ,75% of billed charges for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$12.75 ,75% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.27 ,105% GA Medicaid fee schedule for outpatient setting,$13.26 ,78% of billed charges for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$11.90 ,70% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.75 ,75% of billed charges for outpatient setting,$14.11 ,83% of billed charges for outpatient setting,$8.50 ,50% of billed charges for outpatient setting,$8.50 ,50% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.09 ,102% GA Medicaid fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,$14.11 ,$8.50 Outpatient Medical Services,LAB,84100,PHOSPHORUS,300,$18.00 ,$12.60 ,70% of total billed charges for outpatient setting,$4.74 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$13.50 ,75% of billed charges for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$13.50 ,75% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.27 ,105% GA Medicaid fee schedule for outpatient setting,$14.04 ,78% of billed charges for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$12.60 ,70% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.50 ,75% of billed charges for outpatient setting,$14.94 ,83% of billed charges for outpatient setting,$9.00 ,50% of billed charges for outpatient setting,$9.00 ,50% of billed charges for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.09 ,102% GA Medicaid fee schedule for outpatient setting,$4.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,$14.94 ,$9.00 Outpatient Medical Services,LAB,84132,POTASSIUM,300,$16.00 ,$11.20 ,70% of total billed charges for outpatient setting,$4.76 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$5.78 ,100% GA Medicaid fee schedule for outpatient setting,$5.78 ,100% GA Medicaid fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$5.68 ,100% Anthem fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.07 ,105% GA Medicaid fee schedule for outpatient setting,$12.48 ,78% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$13.28 ,83% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.90 ,102% GA Medicaid fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.76 ,$13.28 ,$8.00 Outpatient Medical Services,LAB,84156,PROTEIN URINE,300,$22.00 ,$15.40 ,70% of total billed charges for outpatient setting,$3.67 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$16.50 ,75% of billed charges for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$16.50 ,75% of billed charges for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.84 ,105% GA Medicaid fee schedule for outpatient setting,$17.16 ,78% of billed charges for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$15.40 ,70% of billed charges for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.50 ,75% of billed charges for outpatient setting,$18.26 ,83% of billed charges for outpatient setting,$11.00 ,50% of billed charges for outpatient setting,$11.00 ,50% of billed charges for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.70 ,102% GA Medicaid fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.67 ,$18.26 ,$11.00 Outpatient Medical Services,LAB,84403,TESTOSTERONE,300,$332.00 ,$232.40 ,70% of total billed charges for outpatient setting,$25.81 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$32.47 ,100% GA Medicaid fee schedule for outpatient setting,$32.47 ,100% GA Medicaid fee schedule for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$249.00 ,75% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$249.00 ,75% of billed charges for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.09 ,105% GA Medicaid fee schedule for outpatient setting,$258.96 ,78% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.00 ,75% of billed charges for outpatient setting,$275.56 ,83% of billed charges for outpatient setting,$166.00 ,50% of billed charges for outpatient setting,$166.00 ,50% of billed charges for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.12 ,102% GA Medicaid fee schedule for outpatient setting,$25.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.81 ,$275.56 ,$166.00 Outpatient Medical Services,LAB,84436,T4,300,$28.00 ,$19.60 ,70% of total billed charges for outpatient setting,$6.87 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.65 ,100% GA Medicaid fee schedule for outpatient setting,$8.65 ,100% GA Medicaid fee schedule for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.08 ,105% GA Medicaid fee schedule for outpatient setting,$21.84 ,78% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$23.24 ,83% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.82 ,102% GA Medicaid fee schedule for outpatient setting,$6.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.87 ,$23.24 ,$14.00 Outpatient Medical Services,LAB,84439,FREE T4,300,$50.00 ,$35.00 ,70% of total billed charges for outpatient setting,$9.02 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.91 ,105% GA Medicaid fee schedule for outpatient setting,$39.00 ,78% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$41.50 ,83% of billed charges for outpatient setting,$25.00 ,50% of billed charges for outpatient setting,$25.00 ,50% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.57 ,102% GA Medicaid fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,$41.50 ,$25.00 Outpatient Medical Services,LAB,84439,FREE T4,300,$50.00 ,$35.00 ,70% of total billed charges for outpatient setting,$9.02 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.91 ,105% GA Medicaid fee schedule for outpatient setting,$39.00 ,78% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$35.00 ,70% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of billed charges for outpatient setting,$41.50 ,83% of billed charges for outpatient setting,$25.00 ,50% of billed charges for outpatient setting,$25.00 ,50% of billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.57 ,102% GA Medicaid fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,$41.50 ,$25.00 Outpatient Medical Services,LAB,84443,TSH,300,$65.00 ,$45.50 ,70% of total billed charges for outpatient setting,$16.80 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.18 ,105% GA Medicaid fee schedule for outpatient setting,$50.70 ,78% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$53.95 ,83% of billed charges for outpatient setting,$32.50 ,50% of billed charges for outpatient setting,$32.50 ,50% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.54 ,102% GA Medicaid fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,$53.95 ,$32.50 Outpatient Medical Services,LAB,84443,TSH,300,$65.00 ,$45.50 ,70% of total billed charges for outpatient setting,$16.80 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.18 ,105% GA Medicaid fee schedule for outpatient setting,$50.70 ,78% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$45.50 ,70% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.75 ,75% of billed charges for outpatient setting,$53.95 ,83% of billed charges for outpatient setting,$32.50 ,50% of billed charges for outpatient setting,$32.50 ,50% of billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.54 ,102% GA Medicaid fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,$53.95 ,$32.50 Outpatient Medical Services,LAB,84484,TROPONIN-HS,300,$66.00 ,$46.20 ,70% of total billed charges for outpatient setting,$12.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.00 ,105% GA Medicaid fee schedule for outpatient setting,$51.48 ,78% of billed charges for outpatient setting,$46.20 ,70% of billed charges for outpatient setting,$46.20 ,70% of billed charges for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,75% of billed charges for outpatient setting,$54.78 ,83% of billed charges for outpatient setting,$33.00 ,50% of billed charges for outpatient setting,$33.00 ,50% of billed charges for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.63 ,102% GA Medicaid fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.38 ,$54.78 ,$33.00 Outpatient Medical Services,LAB,84484,TROPONIN,300,$70.00 ,$49.00 ,70% of total billed charges for outpatient setting,$12.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% Anthem fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.00 ,105% GA Medicaid fee schedule for outpatient setting,$54.60 ,78% of billed charges for outpatient setting,$49.00 ,70% of billed charges for outpatient setting,$49.00 ,70% of billed charges for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.50 ,75% of billed charges for outpatient setting,$58.10 ,83% of billed charges for outpatient setting,$35.00 ,50% of billed charges for outpatient setting,$35.00 ,50% of billed charges for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.63 ,102% GA Medicaid fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.38 ,$58.10 ,$35.00 Outpatient Medical Services,LAB,84550,URIC ACID,300,$19.00 ,$13.30 ,70% of total billed charges for outpatient setting,$4.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.96 ,105% GA Medicaid fee schedule for outpatient setting,$14.82 ,78% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$15.77 ,83% of billed charges for outpatient setting,$9.50 ,50% of billed charges for outpatient setting,$9.50 ,50% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.79 ,102% GA Medicaid fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,$15.77 ,$9.50 Outpatient Medical Services,LAB,84550,URIC ACID,300,$19.00 ,$13.30 ,70% of total billed charges for outpatient setting,$4.51 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.96 ,105% GA Medicaid fee schedule for outpatient setting,$14.82 ,78% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$13.30 ,70% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.25 ,75% of billed charges for outpatient setting,$15.77 ,83% of billed charges for outpatient setting,$9.50 ,50% of billed charges for outpatient setting,$9.50 ,50% of billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.79 ,102% GA Medicaid fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,$15.77 ,$9.50 Outpatient Medical Services,LAB,85007,CHARGE FOR MANUAL DIFF,300,$29.00 ,$20.30 ,70% of total billed charges for outpatient setting,$3.80 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.55 ,105% GA Medicaid fee schedule for outpatient setting,$22.62 ,78% of billed charges for outpatient setting,$20.30 ,70% of billed charges for outpatient setting,$20.30 ,70% of billed charges for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.75 ,75% of billed charges for outpatient setting,$24.07 ,83% of billed charges for outpatient setting,$14.50 ,50% of billed charges for outpatient setting,$14.50 ,50% of billed charges for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.42 ,102% GA Medicaid fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,$24.07 ,$14.50 Outpatient Medical Services,LAB,85007,CHARGE FOR MANUAL DIFF,300,$28.00 ,$19.60 ,70% of total billed charges for outpatient setting,$3.80 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$4.24 ,100% Anthem fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.55 ,105% GA Medicaid fee schedule for outpatient setting,$21.84 ,78% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$19.60 ,70% of billed charges for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.00 ,75% of billed charges for outpatient setting,$23.24 ,83% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$14.00 ,50% of billed charges for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.42 ,102% GA Medicaid fee schedule for outpatient setting,$3.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.80 ,$23.24 ,$14.00 Outpatient Medical Services,LAB,85025,CHARGE FOR CBC W/DIFF,300,$135.00 ,$94.50 ,70% of total billed charges for outpatient setting,$7.77 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.26 ,105% GA Medicaid fee schedule for outpatient setting,$105.30 ,78% of billed charges for outpatient setting,$94.50 ,70% of billed charges for outpatient setting,$94.50 ,70% of billed charges for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$101.25 ,75% of billed charges for outpatient setting,$112.05 ,83% of billed charges for outpatient setting,$67.50 ,50% of billed charges for outpatient setting,$67.50 ,50% of billed charges for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.97 ,102% GA Medicaid fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,$112.05 ,$67.50 Outpatient Medical Services,LAB,85025,CHARGE FOR CBC W/DIFF,300,$133.00 ,$93.10 ,70% of total billed charges for outpatient setting,$7.77 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$9.59 ,100% Anthem fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.26 ,105% GA Medicaid fee schedule for outpatient setting,$103.74 ,78% of billed charges for outpatient setting,$93.10 ,70% of billed charges for outpatient setting,$93.10 ,70% of billed charges for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.75 ,75% of billed charges for outpatient setting,$110.39 ,83% of billed charges for outpatient setting,$66.50 ,50% of billed charges for outpatient setting,$66.50 ,50% of billed charges for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.97 ,102% GA Medicaid fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,$110.39 ,$66.50 Outpatient Medical Services,LAB,85027,CBC W/O DIFF,300,$103.00 ,$72.10 ,70% of total billed charges for outpatient setting,$6.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.55 ,105% GA Medicaid fee schedule for outpatient setting,$80.34 ,78% of billed charges for outpatient setting,$72.10 ,70% of billed charges for outpatient setting,$72.10 ,70% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.25 ,75% of billed charges for outpatient setting,$85.49 ,83% of billed charges for outpatient setting,$51.50 ,50% of billed charges for outpatient setting,$51.50 ,50% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.30 ,102% GA Medicaid fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,$85.49 ,$51.50 Outpatient Medical Services,LAB,85027,CBC WITH MANUAL DIFF,300,$151.00 ,$105.70 ,70% of total billed charges for outpatient setting,$6.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.55 ,105% GA Medicaid fee schedule for outpatient setting,$117.78 ,78% of billed charges for outpatient setting,$105.70 ,70% of billed charges for outpatient setting,$105.70 ,70% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.25 ,75% of billed charges for outpatient setting,$125.33 ,83% of billed charges for outpatient setting,$75.50 ,50% of billed charges for outpatient setting,$75.50 ,50% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.30 ,102% GA Medicaid fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,$125.33 ,$75.50 Outpatient Medical Services,LAB,85027,CBC W/O DIFF,300,$105.00 ,$73.50 ,70% of total billed charges for outpatient setting,$6.47 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$7.98 ,100% Anthem fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.55 ,105% GA Medicaid fee schedule for outpatient setting,$81.90 ,78% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$73.50 ,70% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.75 ,75% of billed charges for outpatient setting,$87.15 ,83% of billed charges for outpatient setting,$52.50 ,50% of billed charges for outpatient setting,$52.50 ,50% of billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.30 ,102% GA Medicaid fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,$87.15 ,$52.50 Outpatient Medical Services,LAB,85379,D DIMER,300,$172.00 ,$120.40 ,70% of total billed charges for outpatient setting,$10.18 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.44 ,105% GA Medicaid fee schedule for outpatient setting,$134.16 ,78% of billed charges for outpatient setting,$120.40 ,70% of billed charges for outpatient setting,$120.40 ,70% of billed charges for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$129.00 ,75% of billed charges for outpatient setting,$142.76 ,83% of billed charges for outpatient setting,$86.00 ,50% of billed charges for outpatient setting,$86.00 ,50% of billed charges for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.06 ,102% GA Medicaid fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,$142.76 ,$86.00 Outpatient Medical Services,LAB,85379,D-DIMER TRI,300,$182.00 ,$127.40 ,70% of total billed charges for outpatient setting,$10.18 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$12.56 ,100% Anthem fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.44 ,105% GA Medicaid fee schedule for outpatient setting,$141.96 ,78% of billed charges for outpatient setting,$127.40 ,70% of billed charges for outpatient setting,$127.40 ,70% of billed charges for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$136.50 ,75% of billed charges for outpatient setting,$151.06 ,83% of billed charges for outpatient setting,$91.00 ,50% of billed charges for outpatient setting,$91.00 ,50% of billed charges for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.06 ,102% GA Medicaid fee schedule for outpatient setting,$10.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,$151.06 ,$91.00 Outpatient Medical Services,LAB,85610,PROTHROMBIN TIME,300,$14.00 ,$9.80 ,70% of total billed charges for outpatient setting,$4.29 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.19 ,105% GA Medicaid fee schedule for outpatient setting,$10.92 ,78% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.50 ,75% of billed charges for outpatient setting,$11.62 ,83% of billed charges for outpatient setting,$7.00 ,50% of billed charges for outpatient setting,$7.00 ,50% of billed charges for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.04 ,102% GA Medicaid fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,$11.62 ,$7.00 Outpatient Medical Services,LAB,85610,PROTHROMBIN TIME,300,$14.00 ,$9.80 ,70% of total billed charges for outpatient setting,$4.29 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.85 ,100% Anthem fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.19 ,105% GA Medicaid fee schedule for outpatient setting,$10.92 ,78% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.50 ,75% of billed charges for outpatient setting,$11.62 ,83% of billed charges for outpatient setting,$7.00 ,50% of billed charges for outpatient setting,$7.00 ,50% of billed charges for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.04 ,102% GA Medicaid fee schedule for outpatient setting,$4.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.29 ,$11.62 ,$7.00 Outpatient Medical Services,LAB,85651,SED RATE,300,$71.00 ,$49.70 ,70% of total billed charges for outpatient setting,$4.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.46 ,100% GA Medicaid fee schedule for outpatient setting,$4.46 ,100% GA Medicaid fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.68 ,105% GA Medicaid fee schedule for outpatient setting,$55.38 ,78% of billed charges for outpatient setting,$49.70 ,70% of billed charges for outpatient setting,$49.70 ,70% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.25 ,75% of billed charges for outpatient setting,$58.93 ,83% of billed charges for outpatient setting,$35.50 ,50% of billed charges for outpatient setting,$35.50 ,50% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.55 ,102% GA Medicaid fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,$58.93 ,$35.50 Outpatient Medical Services,LAB,85651,SED RATE,300,$73.00 ,$51.10 ,70% of total billed charges for outpatient setting,$4.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.46 ,100% GA Medicaid fee schedule for outpatient setting,$4.46 ,100% GA Medicaid fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.38 ,100% Anthem fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.68 ,105% GA Medicaid fee schedule for outpatient setting,$56.94 ,78% of billed charges for outpatient setting,$51.10 ,70% of billed charges for outpatient setting,$51.10 ,70% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$54.75 ,75% of billed charges for outpatient setting,$60.59 ,83% of billed charges for outpatient setting,$36.50 ,50% of billed charges for outpatient setting,$36.50 ,50% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.55 ,102% GA Medicaid fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,$60.59 ,$36.50 Outpatient Medical Services,LAB,85730,PTT,300,$21.00 ,$14.70 ,70% of total billed charges for outpatient setting,$6.01 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.92 ,105% GA Medicaid fee schedule for outpatient setting,$16.38 ,78% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$17.43 ,83% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.69 ,102% GA Medicaid fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,$17.43 ,$10.50 Outpatient Medical Services,LAB,85730,PTT,300,$21.00 ,$14.70 ,70% of total billed charges for outpatient setting,$6.01 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.92 ,105% GA Medicaid fee schedule for outpatient setting,$16.38 ,78% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$17.43 ,83% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.69 ,102% GA Medicaid fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,$17.43 ,$10.50 Outpatient Medical Services,LAB,85730,PTT,300,$42.00 ,$29.40 ,70% of total billed charges for outpatient setting,$6.01 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$7.42 ,100% Anthem fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.92 ,105% GA Medicaid fee schedule for outpatient setting,$32.76 ,78% of billed charges for outpatient setting,$29.40 ,70% of billed charges for outpatient setting,$29.40 ,70% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.50 ,75% of billed charges for outpatient setting,$34.86 ,83% of billed charges for outpatient setting,$21.00 ,50% of billed charges for outpatient setting,$21.00 ,50% of billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.69 ,102% GA Medicaid fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,$34.86 ,$21.00 Outpatient Medical Services,LAB,86003,SOUTHEASTERN RAST (1 OF 3 BUNDLE),300,$21.00 ,$14.70 ,70% of total billed charges for outpatient setting,$5.22 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.90 ,105% GA Medicaid fee schedule for outpatient setting,$16.38 ,78% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$14.70 ,70% of billed charges for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of billed charges for outpatient setting,$17.43 ,83% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$10.50 ,50% of billed charges for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,102% GA Medicaid fee schedule for outpatient setting,$5.22 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.22 ,$17.43 ,$10.50 Outpatient Medical Services,LAB,86039,ANA TITER,300,$86.00 ,$60.20 ,70% of total billed charges for outpatient setting,$11.16 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$14.04 ,100% GA Medicaid fee schedule for outpatient setting,$14.04 ,100% GA Medicaid fee schedule for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.74 ,105% GA Medicaid fee schedule for outpatient setting,$67.08 ,78% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$60.20 ,70% of billed charges for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.50 ,75% of billed charges for outpatient setting,$71.38 ,83% of billed charges for outpatient setting,$43.00 ,50% of billed charges for outpatient setting,$43.00 ,50% of billed charges for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.32 ,102% GA Medicaid fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.16 ,$71.38 ,$43.00 Outpatient Medical Services,LAB,86140,CRP,300,$118.00 ,$82.60 ,70% of total billed charges for outpatient setting,$5.18 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.84 ,105% GA Medicaid fee schedule for outpatient setting,$92.04 ,78% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$82.60 ,70% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$88.50 ,75% of billed charges for outpatient setting,$97.94 ,83% of billed charges for outpatient setting,$59.00 ,50% of billed charges for outpatient setting,$59.00 ,50% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.64 ,102% GA Medicaid fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,$97.94 ,$59.00 Outpatient Medical Services,LAB,86140,CRP,300,$119.00 ,$83.30 ,70% of total billed charges for outpatient setting,$5.18 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$6.39 ,100% Anthem fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.84 ,105% GA Medicaid fee schedule for outpatient setting,$92.82 ,78% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,$98.77 ,83% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.64 ,102% GA Medicaid fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,$98.77 ,$59.50 Outpatient Medical Services,LAB,86430,RA TEST,300,$114.00 ,$79.80 ,70% of total billed charges for outpatient setting,$6.14 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$7.14 ,100% GA Medicaid fee schedule for outpatient setting,$7.14 ,100% GA Medicaid fee schedule for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.50 ,105% GA Medicaid fee schedule for outpatient setting,$88.92 ,78% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$94.62 ,83% of billed charges for outpatient setting,$57.00 ,50% of billed charges for outpatient setting,$57.00 ,50% of billed charges for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.28 ,102% GA Medicaid fee schedule for outpatient setting,$6.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.14 ,$94.62 ,$57.00 Outpatient Medical Services,LAB,86592,RPR ROUTINE,300,$16.00 ,$11.20 ,70% of total billed charges for outpatient setting,$4.26 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$4.65 ,100% GA Medicaid fee schedule for outpatient setting,$4.65 ,100% GA Medicaid fee schedule for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.88 ,105% GA Medicaid fee schedule for outpatient setting,$12.48 ,78% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$11.20 ,70% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,75% of billed charges for outpatient setting,$13.28 ,83% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$8.00 ,50% of billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.74 ,102% GA Medicaid fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,$13.28 ,$8.00 Outpatient Medical Services,LAB,86695,HERPES SIMPLEX VIRUS AB PANEL,300,$94.00 ,$65.80 ,70% of total billed charges for outpatient setting,$13.19 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$16.59 ,100% GA Medicaid fee schedule for outpatient setting,$16.59 ,100% GA Medicaid fee schedule for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$70.50 ,75% of billed charges for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$70.50 ,75% of billed charges for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.42 ,105% GA Medicaid fee schedule for outpatient setting,$73.32 ,78% of billed charges for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$65.80 ,70% of billed charges for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$70.50 ,75% of billed charges for outpatient setting,$78.02 ,83% of billed charges for outpatient setting,$47.00 ,50% of billed charges for outpatient setting,$47.00 ,50% of billed charges for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.92 ,102% GA Medicaid fee schedule for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.19 ,$78.02 ,$47.00 Outpatient Medical Services,LAB,86696,HERPES SIMPLEX PANEL,300,$137.00 ,$95.90 ,70% of total billed charges for outpatient setting,$19.35 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$24.35 ,100% GA Medicaid fee schedule for outpatient setting,$24.35 ,100% GA Medicaid fee schedule for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$102.75 ,75% of billed charges for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$102.75 ,75% of billed charges for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.57 ,105% GA Medicaid fee schedule for outpatient setting,$106.86 ,78% of billed charges for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$95.90 ,70% of billed charges for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$102.75 ,75% of billed charges for outpatient setting,$113.71 ,83% of billed charges for outpatient setting,$68.50 ,50% of billed charges for outpatient setting,$68.50 ,50% of billed charges for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.84 ,102% GA Medicaid fee schedule for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.35 ,$113.71 ,$68.50 Outpatient Medical Services,LAB,86703,HIV AB,300,$49.00 ,$34.30 ,70% of total billed charges for outpatient setting,$13.71 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$14.96 ,100% GA Medicaid fee schedule for outpatient setting,$14.96 ,100% GA Medicaid fee schedule for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.71 ,105% GA Medicaid fee schedule for outpatient setting,$38.22 ,78% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$34.30 ,70% of billed charges for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$40.67 ,83% of billed charges for outpatient setting,$24.50 ,50% of billed charges for outpatient setting,$24.50 ,50% of billed charges for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.26 ,102% GA Medicaid fee schedule for outpatient setting,$13.71 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.71 ,$40.67 ,$24.50 Outpatient Medical Services,LAB,86756,RESP SYNTICAL VIRUS,300,$43.00 ,$30.10 ,70% of total billed charges for outpatient setting,$15.89 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$16.21 ,100% GA Medicaid fee schedule for outpatient setting,$16.21 ,100% GA Medicaid fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.91 ,100% Anthem fee schedule for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.02 ,105% GA Medicaid fee schedule for outpatient setting,$33.54 ,78% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$30.10 ,70% of billed charges for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.25 ,75% of billed charges for outpatient setting,$35.69 ,83% of billed charges for outpatient setting,$21.50 ,50% of billed charges for outpatient setting,$21.50 ,50% of billed charges for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.53 ,102% GA Medicaid fee schedule for outpatient setting,$15.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.89 ,$35.69 ,$21.50 Outpatient Medical Services,LAB,87040,BLOOD CULTU,300,$34.00 ,$23.80 ,70% of total billed charges for outpatient setting,$10.32 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$12.98 ,100% GA Medicaid fee schedule for outpatient setting,$12.98 ,100% GA Medicaid fee schedule for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$25.50 ,75% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$25.50 ,75% of billed charges for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,105% GA Medicaid fee schedule for outpatient setting,$26.52 ,78% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$23.80 ,70% of billed charges for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.50 ,75% of billed charges for outpatient setting,$28.22 ,83% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$17.00 ,50% of billed charges for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.24 ,102% GA Medicaid fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.32 ,$28.22 ,$17.00 Outpatient Medical Services,LAB,87045,STOOL CULTURE,300,$67.00 ,$46.90 ,70% of total billed charges for outpatient setting,$9.44 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$25.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$11.66 ,100% Anthem fee schedule for outpatient setting,$11.66 ,100% Anthem fee schedule for outpatient setting,$11.66 ,100% Anthem fee schedule for outpatient setting,$11.66 ,100% Anthem fee schedule for outpatient setting,$11.66 ,100% Anthem fee schedule for outpatient setting,$11.66 ,100% Anthem fee schedule for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.45 ,35% of billed charges for outpatient setting,$52.26 ,78% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$46.90 ,70% of billed charges for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.25 ,75% of billed charges for outpatient setting,$55.61 ,83% of billed charges for outpatient setting,$33.50 ,50% of billed charges for outpatient setting,$33.50 ,50% of billed charges for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.24 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.44 ,$55.61 ,$33.50 Outpatient Medical Services,LAB,87070,CULTURE AEROBIC,300,$59.00 ,$41.30 ,70% of total billed charges for outpatient setting,$8.61 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.37 ,105% GA Medicaid fee schedule for outpatient setting,$46.02 ,78% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$48.97 ,83% of billed charges for outpatient setting,$29.50 ,50% of billed charges for outpatient setting,$29.50 ,50% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.05 ,102% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,$48.97 ,$29.50 Outpatient Medical Services,LAB,87070,CULTURE AEROBIC,300,$59.00 ,$41.30 ,70% of total billed charges for outpatient setting,$8.61 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.37 ,105% GA Medicaid fee schedule for outpatient setting,$46.02 ,78% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$41.30 ,70% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.25 ,75% of billed charges for outpatient setting,$48.97 ,83% of billed charges for outpatient setting,$29.50 ,50% of billed charges for outpatient setting,$29.50 ,50% of billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.05 ,102% GA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,$48.97 ,$29.50 Outpatient Medical Services,LAB,87077,ORGANISM ID,300,$55.00 ,$38.50 ,70% of total billed charges for outpatient setting,$8.08 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.16 ,100% GA Medicaid fee schedule for outpatient setting,$10.16 ,100% GA Medicaid fee schedule for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$41.25 ,75% of billed charges for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$41.25 ,75% of billed charges for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.67 ,105% GA Medicaid fee schedule for outpatient setting,$42.90 ,78% of billed charges for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$38.50 ,70% of billed charges for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.25 ,75% of billed charges for outpatient setting,$45.65 ,83% of billed charges for outpatient setting,$27.50 ,50% of billed charges for outpatient setting,$27.50 ,50% of billed charges for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.36 ,102% GA Medicaid fee schedule for outpatient setting,$8.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.08 ,$45.65 ,$27.50 Outpatient Medical Services,LAB,87088,URINE CULTURE,300,$56.00 ,$39.20 ,70% of total billed charges for outpatient setting,$8.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% GA Medicaid fee schedule for outpatient setting,$10.18 ,100% GA Medicaid fee schedule for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.69 ,105% GA Medicaid fee schedule for outpatient setting,$43.68 ,78% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$46.48 ,83% of billed charges for outpatient setting,$28.00 ,50% of billed charges for outpatient setting,$28.00 ,50% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.38 ,102% GA Medicaid fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,$46.48 ,$28.00 Outpatient Medical Services,LAB,87088,URINE CULTURE,300,$56.00 ,$39.20 ,70% of total billed charges for outpatient setting,$8.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.18 ,100% GA Medicaid fee schedule for outpatient setting,$10.18 ,100% GA Medicaid fee schedule for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.69 ,105% GA Medicaid fee schedule for outpatient setting,$43.68 ,78% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$39.20 ,70% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.00 ,75% of billed charges for outpatient setting,$46.48 ,83% of billed charges for outpatient setting,$28.00 ,50% of billed charges for outpatient setting,$28.00 ,50% of billed charges for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.38 ,102% GA Medicaid fee schedule for outpatient setting,$8.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.09 ,$46.48 ,$28.00 Outpatient Medical Services,LAB,87186,ORGANISM SENS,300,$58.00 ,$40.60 ,70% of total billed charges for outpatient setting,$8.65 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$10.87 ,100% GA Medicaid fee schedule for outpatient setting,$10.87 ,100% GA Medicaid fee schedule for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$43.50 ,75% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$43.50 ,75% of billed charges for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.41 ,105% GA Medicaid fee schedule for outpatient setting,$45.24 ,78% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$40.60 ,70% of billed charges for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$43.50 ,75% of billed charges for outpatient setting,$48.14 ,83% of billed charges for outpatient setting,$29.00 ,50% of billed charges for outpatient setting,$29.00 ,50% of billed charges for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.09 ,102% GA Medicaid fee schedule for outpatient setting,$8.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.65 ,$48.14 ,$29.00 Outpatient Medical Services,LAB,87400,INFLUENZAE,300,$157.00 ,$109.90 ,70% of total billed charges for outpatient setting,$14.13 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.80 ,100% Anthem fee schedule for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.83 ,105% GA Medicaid fee schedule for outpatient setting,$122.46 ,78% of billed charges for outpatient setting,$109.90 ,70% of billed charges for outpatient setting,$109.90 ,70% of billed charges for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.75 ,75% of billed charges for outpatient setting,$130.31 ,83% of billed charges for outpatient setting,$78.50 ,50% of billed charges for outpatient setting,$78.50 ,50% of billed charges for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.38 ,102% GA Medicaid fee schedule for outpatient setting,$14.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.13 ,$130.31 ,$78.50 Outpatient Medical Services,LAB,87426,COVID ANTIGEN,300,$114.00 ,$79.80 ,70% of total billed charges for outpatient setting,$35.33 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$36.18 ,100% GA Medicaid fee schedule for outpatient setting,$36.18 ,100% GA Medicaid fee schedule for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.99 ,105% GA Medicaid fee schedule for outpatient setting,$88.92 ,78% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$79.80 ,70% of billed charges for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.50 ,75% of billed charges for outpatient setting,$94.62 ,83% of billed charges for outpatient setting,$57.00 ,50% of billed charges for outpatient setting,$57.00 ,50% of billed charges for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.90 ,102% GA Medicaid fee schedule for outpatient setting,$35.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.33 ,$94.62 ,$57.00 Outpatient Medical Services,LAB,87490,GC/CHLAMY G,300,$136.00 ,$95.20 ,70% of total billed charges for outpatient setting,$22.75 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$24.80 ,100% GA Medicaid fee schedule for outpatient setting,$24.80 ,100% GA Medicaid fee schedule for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.04 ,105% GA Medicaid fee schedule for outpatient setting,$106.08 ,78% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$112.88 ,83% of billed charges for outpatient setting,$68.00 ,50% of billed charges for outpatient setting,$68.00 ,50% of billed charges for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.30 ,102% GA Medicaid fee schedule for outpatient setting,$22.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.75 ,$112.88 ,$68.00 Outpatient Medical Services,LAB,87491,CHLAMYDIA/G,300,$68.00 ,$47.60 ,70% of total billed charges for outpatient setting,$35.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.90 ,105% GA Medicaid fee schedule for outpatient setting,$53.04 ,78% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$56.44 ,83% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.16 ,102% GA Medicaid fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.67 ,$56.44 ,$34.00 Outpatient Medical Services,LAB,87590,GC/CHLAMY G,300,$136.00 ,$95.20 ,70% of total billed charges for outpatient setting,$26.88 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$52.22 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$52.22 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.60 ,35% of billed charges for outpatient setting,$106.08 ,78% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$95.20 ,70% of billed charges for outpatient setting,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$102.00 ,75% of billed charges for outpatient setting,$112.88 ,83% of billed charges for outpatient setting,$68.00 ,50% of billed charges for outpatient setting,$68.00 ,50% of billed charges for outpatient setting,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.26 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$26.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.88 ,$112.88 ,$68.00 Outpatient Medical Services,LAB,87591,CHLAMYDIA/G,300,$68.00 ,$47.60 ,70% of total billed charges for outpatient setting,$35.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.49 ,105% GA Medicaid fee schedule for outpatient setting,$53.04 ,78% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$56.44 ,83% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.85 ,102% GA Medicaid fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.42 ,$56.44 ,$34.00 Outpatient Medical Services,LAB,87661,TRICHOMONAS VAGINALIS,300,$68.00 ,$47.60 ,70% of total billed charges for outpatient setting,$35.09 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.49 ,105% GA Medicaid fee schedule for outpatient setting,$53.04 ,78% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$47.60 ,70% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.00 ,75% of billed charges for outpatient setting,$56.44 ,83% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$34.00 ,50% of billed charges for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.85 ,102% GA Medicaid fee schedule for outpatient setting,$35.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.42 ,$56.44 ,$34.00 Outpatient Medical Services,LAB,87880,STREP SCREEN,300,$40.00 ,$28.00 ,70% of total billed charges for outpatient setting,$16.53 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% Anthem fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.83 ,105% GA Medicaid fee schedule for outpatient setting,$31.20 ,78% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.00 ,75% of billed charges for outpatient setting,$33.20 ,83% of billed charges for outpatient setting,$20.00 ,50% of billed charges for outpatient setting,$20.00 ,50% of billed charges for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.38 ,102% GA Medicaid fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,$33.20 ,$20.00 Outpatient Medical Services,LAB,G0103,PSA SCREENING,300,$40.00 ,$28.00 ,70% of total billed charges for outpatient setting,$19.30 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$25.70 ,100% GA Medicaid fee schedule for outpatient setting,$25.70 ,100% GA Medicaid fee schedule for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$30.00 ,75% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$30.00 ,75% of billed charges for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.99 ,105% GA Medicaid fee schedule for outpatient setting,$31.20 ,78% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$28.00 ,70% of billed charges for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.00 ,75% of billed charges for outpatient setting,$33.20 ,83% of billed charges for outpatient setting,$20.00 ,50% of billed charges for outpatient setting,$20.00 ,50% of billed charges for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.21 ,102% GA Medicaid fee schedule for outpatient setting,$19.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.30 ,$33.20 ,$20.00 Outpatient Medical Services,LAB,94640,JET NEB SUBSEQUENT,410,$169.00 ,$118.30 ,70% of total billed charges for outpatient setting,$183.21 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$64.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$64.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.15 ,35% of billed charges for outpatient setting,$131.82 ,78% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$118.30 ,70% of billed charges for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.75 ,75% of billed charges for outpatient setting,$140.27 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.20 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$183.21 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.15 ,$212.00 ,$84.50 Outpatient Medical Services,LAB,94760,O2 SAT CHECK,460,$14.00 ,$9.80 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$5.38 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$5.38 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$9.80 ,70% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$10.50 ,75% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$10.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.90 ,35% of billed charges for outpatient setting,$10.92 ,78% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,$9.80 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$10.50 ,75% of billed charges for outpatient setting,$11.62 ,83% of billed charges for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,$424.00 ,100% UHC case rate for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$5.49 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$4.90 ,$424.00 ,$7.00 Outpatient Medical Services,LAB,J2270,MORPHINE 2 MG INJECTION,636,$7.00 ,$4.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.67 ,100% GA Medicaid fee schedule for outpatient setting,$4.67 ,100% GA Medicaid fee schedule for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.90 ,105% GA Medicaid fee schedule for outpatient setting,$5.46 ,78% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,$4.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$5.25 ,75% of billed charges for outpatient setting,$5.81 ,83% of billed charges for outpatient setting,$3.50 ,50% of billed charges for outpatient setting,$3.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$4.76 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.50 ,$5.81 ,$3.50 Outpatient Medical Services,LAB,J2765,METOCLOPRAMIDE (REGLAN) 10MG/2ML VlAL,636,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.09 ,100% GA Medicaid fee schedule for outpatient setting,$1.09 ,100% GA Medicaid fee schedule for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.14 ,105% GA Medicaid fee schedule for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.11 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.09 ,$4.15 ,$2.50 Outpatient Medical Services,LAB,Q9967,CONTRAST OPTI 350,636,$2.00 ,$1.40 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.77 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$0.77 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.70 ,35% of billed charges for outpatient setting,$1.56 ,78% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,$1.66 ,83% of billed charges for outpatient setting,$1.00 ,50% of billed charges for outpatient setting,$1.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.79 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$0.70 ,$1.66 ,$1.00 Outpatient Medical Services,LAB,63304,ATORVASTATIN (LIPITOR) 20 MG TABLET,637,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,$5.00 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.75 ,35% of billed charges for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.96 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$5.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$1.75 ,$5.00 ,$2.50 Outpatient Medical Services,LAB,80369,CYCLOBENZAPRINE (FLEXERIL) 10 MG TABLET,637,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$22.17 ,100% GA Medicaid fee schedule for outpatient setting,$22.17 ,100% GA Medicaid fee schedule for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$23.28 ,105% GA Medicaid fee schedule for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$22.61 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$2.50 ,$23.28 ,$2.50 Outpatient Medical Services,LAB,J7614,LEVALBUTEROL(XOPENEX) 1.25mg/3mL SOLN,637,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.75 ,35% of billed charges for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.96 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$1.75 ,$4.15 ,$2.50 Outpatient Medical Services,LAB,J1815,HUMULIN R INSULIN,637,$5.00 ,$3.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.31 ,100% GA Medicaid fee schedule for outpatient setting,$0.31 ,100% GA Medicaid fee schedule for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.33 ,105% GA Medicaid fee schedule for outpatient setting,$3.90 ,78% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,$3.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$3.75 ,75% of billed charges for outpatient setting,$4.15 ,83% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,$2.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.32 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.31 ,$4.15 ,$2.50 Outpatient Medical Services,RADIOLOGY,70540,"MRI ORBIT,HEAD NECK W/O CONTRA",610,$722.00 ,$505.40 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$277.25 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$277.25 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.70 ,35% of billed charges for outpatient setting,$563.16 ,78% of billed charges for outpatient setting,$505.40 ,70% of billed charges for outpatient setting,$505.40 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$541.50 ,75% of billed charges for outpatient setting,$599.26 ,83% of billed charges for outpatient setting,$361.00 ,50% of billed charges for outpatient setting,$361.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$282.80 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,$600.00 ,$361.00 Outpatient Medical Services,RADIOLOGY,72195,MRI PELVIS W/O CONTRAST,610,"$1,910.00 ","$1,337.00 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$733.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$733.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$668.50 ,35% of billed charges for outpatient setting,"$1,489.80 ",78% of billed charges for outpatient setting,"$1,337.00 ",70% of billed charges for outpatient setting,"$1,337.00 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,432.50 ",75% of billed charges for outpatient setting,"$1,585.30 ",83% of billed charges for outpatient setting,$955.00 ,50% of billed charges for outpatient setting,$955.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$748.11 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$1,585.30 ",$955.00 Outpatient Medical Services,RADIOLOGY,72197,MRI PELVIS W&WO CONTRAST,610,"$4,476.00 ","$3,133.20 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,718.78 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,718.78 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,566.60 ",35% of billed charges for outpatient setting,"$3,491.28 ",78% of billed charges for outpatient setting,"$3,133.20 ",70% of billed charges for outpatient setting,"$3,133.20 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,357.00 ",75% of billed charges for outpatient setting,"$3,715.08 ",83% of billed charges for outpatient setting,"$2,238.00 ",50% of billed charges for outpatient setting,"$2,238.00 ",50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,753.16 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$3,715.08 ","$2,238.00 " Outpatient Medical Services,RADIOLOGY,73218,MRI UP EXT NONJOINT W/O CONT R,610,$870.00 ,$609.00 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$334.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$334.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$304.50 ,35% of billed charges for outpatient setting,$678.60 ,78% of billed charges for outpatient setting,$609.00 ,70% of billed charges for outpatient setting,$609.00 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$652.50 ,75% of billed charges for outpatient setting,$722.10 ,83% of billed charges for outpatient setting,$435.00 ,50% of billed charges for outpatient setting,$435.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$340.76 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,$722.10 ,$435.00 Outpatient Medical Services,RADIOLOGY,73218,MRI UP EXT NONJOINT W/O CONT L,610,$870.00 ,$609.00 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$334.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$334.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$304.50 ,35% of billed charges for outpatient setting,$678.60 ,78% of billed charges for outpatient setting,$609.00 ,70% of billed charges for outpatient setting,$609.00 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$652.50 ,75% of billed charges for outpatient setting,$722.10 ,83% of billed charges for outpatient setting,$435.00 ,50% of billed charges for outpatient setting,$435.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$340.76 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,$722.10 ,$435.00 Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER JOINT W/O CONT LEFT,610,"$2,938.00 ","$2,056.60 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,128.19 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,128.19 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,028.30 ",35% of billed charges for outpatient setting,"$2,291.64 ",78% of billed charges for outpatient setting,"$2,056.60 ",70% of billed charges for outpatient setting,"$2,056.60 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,203.50 ",75% of billed charges for outpatient setting,"$2,438.54 ",83% of billed charges for outpatient setting,"$1,469.00 ",50% of billed charges for outpatient setting,"$1,469.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.75 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,438.54 ","$1,469.00 " Outpatient Medical Services,RADIOLOGY,73221,MRI UPPER JOINT W/O CONT RIGHT,610,"$2,676.00 ","$1,873.20 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$936.60 ,35% of billed charges for outpatient setting,"$2,087.28 ",78% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,007.00 ",75% of billed charges for outpatient setting,"$2,221.08 ",83% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,048.13 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,221.08 ","$1,338.00 " Outpatient Medical Services,RADIOLOGY,73223,MRI UPPER EXT JOINT W&WO CONT,610,"$1,123.00 ",$786.10 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$431.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$431.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$393.05 ,35% of billed charges for outpatient setting,$875.94 ,78% of billed charges for outpatient setting,$786.10 ,70% of billed charges for outpatient setting,$786.10 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$842.25 ,75% of billed charges for outpatient setting,$932.09 ,83% of billed charges for outpatient setting,$561.50 ,50% of billed charges for outpatient setting,$561.50 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$439.85 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,$932.09 ,$561.50 Outpatient Medical Services,RADIOLOGY,73718,MRI LOW EXT NONJOINT W/O CONT,610,"$2,676.00 ","$1,873.20 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$936.60 ,35% of billed charges for outpatient setting,"$2,087.28 ",78% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,007.00 ",75% of billed charges for outpatient setting,"$2,221.08 ",83% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,048.13 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,221.08 ","$1,338.00 " Outpatient Medical Services,RADIOLOGY,73718,MRI LOW EXT NONJOINT W/O CONT,610,"$2,676.00 ","$1,873.20 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$936.60 ,35% of billed charges for outpatient setting,"$2,087.28 ",78% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,007.00 ",75% of billed charges for outpatient setting,"$2,221.08 ",83% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,048.13 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,221.08 ","$1,338.00 " Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT NON-JOINT W&WO C,610,"$1,198.00 ",$838.60 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$460.03 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$460.03 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$419.30 ,35% of billed charges for outpatient setting,$934.44 ,78% of billed charges for outpatient setting,$838.60 ,70% of billed charges for outpatient setting,$838.60 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.50 ,75% of billed charges for outpatient setting,$994.34 ,83% of billed charges for outpatient setting,$599.00 ,50% of billed charges for outpatient setting,$599.00 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$469.23 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,$994.34 ,$599.00 Outpatient Medical Services,RADIOLOGY,73720,MRI LOWER EXT NON-JOINT W&WO C,610,"$1,198.00 ",$838.60 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$460.03 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$460.03 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$419.30 ,35% of billed charges for outpatient setting,$934.44 ,78% of billed charges for outpatient setting,$838.60 ,70% of billed charges for outpatient setting,$838.60 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$898.50 ,75% of billed charges for outpatient setting,$994.34 ,83% of billed charges for outpatient setting,$599.00 ,50% of billed charges for outpatient setting,$599.00 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$469.23 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,$994.34 ,$599.00 Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT W/O CONT R,610,"$2,868.00 ","$2,007.60 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,101.31 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,101.31 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,003.80 ",35% of billed charges for outpatient setting,"$2,237.04 ",78% of billed charges for outpatient setting,"$2,007.60 ",70% of billed charges for outpatient setting,"$2,007.60 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,151.00 ",75% of billed charges for outpatient setting,"$2,380.44 ",83% of billed charges for outpatient setting,"$1,434.00 ",50% of billed charges for outpatient setting,"$1,434.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,123.34 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,380.44 ","$1,434.00 " Outpatient Medical Services,RADIOLOGY,73721,MRI LOWER EXT JOINT W/O CONT L,610,"$3,084.00 ","$2,158.80 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,184.26 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,184.26 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,079.40 ",35% of billed charges for outpatient setting,"$2,405.52 ",78% of billed charges for outpatient setting,"$2,158.80 ",70% of billed charges for outpatient setting,"$2,158.80 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,313.00 ",75% of billed charges for outpatient setting,"$2,559.72 ",83% of billed charges for outpatient setting,"$1,542.00 ",50% of billed charges for outpatient setting,"$1,542.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,207.95 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,559.72 ","$1,542.00 " Outpatient Medical Services,RADIOLOGY,73723,MRI LOW EXT JOINT W&WO CONT RI,610,"$1,124.00 ",$786.80 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$431.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$431.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$393.40 ,35% of billed charges for outpatient setting,$876.72 ,78% of billed charges for outpatient setting,$786.80 ,70% of billed charges for outpatient setting,$786.80 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$843.00 ,75% of billed charges for outpatient setting,$932.92 ,83% of billed charges for outpatient setting,$562.00 ,50% of billed charges for outpatient setting,$562.00 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$440.25 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,$932.92 ,$562.00 Outpatient Medical Services,RADIOLOGY,73723,MRI LOW EXT JOINT W&WO CONT LE,610,"$1,124.00 ",$786.80 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$431.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$431.62 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$393.40 ,35% of billed charges for outpatient setting,$876.72 ,78% of billed charges for outpatient setting,$786.80 ,70% of billed charges for outpatient setting,$786.80 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$843.00 ,75% of billed charges for outpatient setting,$932.92 ,83% of billed charges for outpatient setting,$562.00 ,50% of billed charges for outpatient setting,$562.00 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$440.25 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,$932.92 ,$562.00 Outpatient Medical Services,RADIOLOGY,74181,MRI-ABDOMEN W/O CONTRAST,610,$910.00 ,$637.00 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$349.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$349.44 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$318.50 ,35% of billed charges for outpatient setting,$709.80 ,78% of billed charges for outpatient setting,$637.00 ,70% of billed charges for outpatient setting,$637.00 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$682.50 ,75% of billed charges for outpatient setting,$755.30 ,83% of billed charges for outpatient setting,$455.00 ,50% of billed charges for outpatient setting,$455.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$356.43 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,$755.30 ,$455.00 Outpatient Medical Services,RADIOLOGY,74183,MRI ABD W/ & W/O CONTRAST,610,"$1,210.00 ",$847.00 ,70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$464.64 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$464.64 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$423.50 ,35% of billed charges for outpatient setting,$943.80 ,78% of billed charges for outpatient setting,$847.00 ,70% of billed charges for outpatient setting,$847.00 ,70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$907.50 ,75% of billed charges for outpatient setting,"$1,004.30 ",83% of billed charges for outpatient setting,$605.00 ,50% of billed charges for outpatient setting,$605.00 ,50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$473.93 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$1,004.30 ",$605.00 Outpatient Medical Services,RADIOLOGY,70544,MRA HEAD W/O CONTRAST,611,"$2,676.00 ","$1,873.20 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,027.58 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$936.60 ,35% of billed charges for outpatient setting,"$2,087.28 ",78% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,"$1,873.20 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,007.00 ",75% of billed charges for outpatient setting,"$2,221.08 ",83% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,"$1,338.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,048.13 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,221.08 ","$1,338.00 " Outpatient Medical Services,RADIOLOGY,70551,MRI BRAIN W/O CONTRS,611,"$1,829.00 ","$1,280.30 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$702.34 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$702.34 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$640.15 ,35% of billed charges for outpatient setting,"$1,426.62 ",78% of billed charges for outpatient setting,"$1,280.30 ",70% of billed charges for outpatient setting,"$1,280.30 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,371.75 ",75% of billed charges for outpatient setting,"$1,518.07 ",83% of billed charges for outpatient setting,$914.50 ,50% of billed charges for outpatient setting,$914.50 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$716.39 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$1,518.07 ",$914.50 Outpatient Medical Services,RADIOLOGY,70553,MRI BRAIN W&W/O CONT,611,"$4,953.00 ","$3,467.10 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,901.95 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,901.95 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,733.55 ",35% of billed charges for outpatient setting,"$3,863.34 ",78% of billed charges for outpatient setting,"$3,467.10 ",70% of billed charges for outpatient setting,"$3,467.10 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,714.75 ",75% of billed charges for outpatient setting,"$4,110.99 ",83% of billed charges for outpatient setting,"$2,476.50 ",50% of billed charges for outpatient setting,"$2,476.50 ",50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,939.99 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$4,110.99 ","$2,476.50 " Outpatient Medical Services,RADIOLOGY,72141,MRI C-SPINE W/O CONT,612,"$2,917.00 ","$2,041.90 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,120.13 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,120.13 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,020.95 ",35% of billed charges for outpatient setting,"$2,275.26 ",78% of billed charges for outpatient setting,"$2,041.90 ",70% of billed charges for outpatient setting,"$2,041.90 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,187.75 ",75% of billed charges for outpatient setting,"$2,421.11 ",83% of billed charges for outpatient setting,"$1,458.50 ",50% of billed charges for outpatient setting,"$1,458.50 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,142.53 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,421.11 ","$1,458.50 " Outpatient Medical Services,RADIOLOGY,72146,MRI T-SPINE W/O CONT,612,$547.00 ,$382.90 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$210.05 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$210.05 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.45 ,35% of billed charges for outpatient setting,$426.66 ,78% of billed charges for outpatient setting,$382.90 ,70% of billed charges for outpatient setting,$382.90 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$410.25 ,75% of billed charges for outpatient setting,$454.01 ,83% of billed charges for outpatient setting,$273.50 ,50% of billed charges for outpatient setting,$273.50 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.25 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.45 ,$600.00 ,$273.50 Outpatient Medical Services,RADIOLOGY,72148,MRI L-SPINE W/O CONT,612,"$2,982.00 ","$2,087.40 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,145.09 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,145.09 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,043.70 ",35% of billed charges for outpatient setting,"$2,325.96 ",78% of billed charges for outpatient setting,"$2,087.40 ",70% of billed charges for outpatient setting,"$2,087.40 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,236.50 ",75% of billed charges for outpatient setting,"$2,475.06 ",83% of billed charges for outpatient setting,"$1,491.00 ",50% of billed charges for outpatient setting,"$1,491.00 ",50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,167.99 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$2,475.06 ","$1,491.00 " Outpatient Medical Services,RADIOLOGY,72156,MRI C-SPINE W&W/O CO,612,"$3,197.00 ","$2,237.90 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,227.65 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,227.65 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,118.95 ",35% of billed charges for outpatient setting,"$2,493.66 ",78% of billed charges for outpatient setting,"$2,237.90 ",70% of billed charges for outpatient setting,"$2,237.90 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,397.75 ",75% of billed charges for outpatient setting,"$2,653.51 ",83% of billed charges for outpatient setting,"$1,598.50 ",50% of billed charges for outpatient setting,"$1,598.50 ",50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,252.20 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$2,653.51 ","$1,598.50 " Outpatient Medical Services,RADIOLOGY,72157,MRI T-SPINE W&W/O CO,612,"$3,197.00 ","$2,237.90 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,227.65 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,227.65 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,118.95 ",35% of billed charges for outpatient setting,"$2,493.66 ",78% of billed charges for outpatient setting,"$2,237.90 ",70% of billed charges for outpatient setting,"$2,237.90 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,397.75 ",75% of billed charges for outpatient setting,"$2,653.51 ",83% of billed charges for outpatient setting,"$1,598.50 ",50% of billed charges for outpatient setting,"$1,598.50 ",50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,252.20 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$2,653.51 ","$1,598.50 " Outpatient Medical Services,RADIOLOGY,72158,MRI L-SPINE W&W/O CO,612,"$4,476.00 ","$3,133.20 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,718.78 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,718.78 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$600.00 ,100% Anthem MRI case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,566.60 ",35% of billed charges for outpatient setting,"$3,491.28 ",78% of billed charges for outpatient setting,"$3,133.20 ",70% of billed charges for outpatient setting,"$3,133.20 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,357.00 ",75% of billed charges for outpatient setting,"$3,715.08 ",83% of billed charges for outpatient setting,"$2,238.00 ",50% of billed charges for outpatient setting,"$2,238.00 ",50% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,753.16 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$3,715.08 ","$2,238.00 " Outpatient Medical Services,RADIOLOGY,78014,NM THYROIS SCAN/UPTAKE,341,"$1,737.00 ","$1,215.90 ",70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$667.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$667.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$438.14 ,100% Anthem fee schedule for outpatient setting,$438.14 ,100% Anthem fee schedule for outpatient setting,$438.14 ,100% Anthem fee schedule for outpatient setting,$438.14 ,100% Anthem fee schedule for outpatient setting,$438.14 ,100% Anthem fee schedule for outpatient setting,$438.14 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$607.95 ,35% of billed charges for outpatient setting,"$1,354.86 ",78% of billed charges for outpatient setting,"$1,215.90 ",70% of billed charges for outpatient setting,"$1,215.90 ",70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,302.75 ",75% of billed charges for outpatient setting,"$1,441.71 ",83% of billed charges for outpatient setting,"$2,779.20 ",100% UHC case rate for outpatient setting,"$2,779.20 ",100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$680.35 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,"$2,779.20 ",$868.50 Outpatient Medical Services,RADIOLOGY,78071,NM PARATHYROID PLANAR W/SPECT,341,"$2,086.00 ","$1,460.20 ",70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$801.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$801.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$604.98 ,100% Anthem fee schedule for outpatient setting,$604.98 ,100% Anthem fee schedule for outpatient setting,$604.98 ,100% Anthem fee schedule for outpatient setting,$604.98 ,100% Anthem fee schedule for outpatient setting,$604.98 ,100% Anthem fee schedule for outpatient setting,$604.98 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$730.10 ,35% of billed charges for outpatient setting,"$1,627.08 ",78% of billed charges for outpatient setting,"$1,460.20 ",70% of billed charges for outpatient setting,"$1,460.20 ",70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,564.50 ",75% of billed charges for outpatient setting,"$1,731.38 ",83% of billed charges for outpatient setting,"$3,337.60 ",100% UHC case rate for outpatient setting,"$3,337.60 ",100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$817.04 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,"$3,337.60 ","$1,043.00 " Outpatient Medical Services,RADIOLOGY,78227,NM HIDA W/EF,341,"$2,254.00 ","$1,577.80 ",70% of total billed charges for outpatient setting,$464.28 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$865.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$865.54 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$816.45 ,100% Anthem fee schedule for outpatient setting,$816.45 ,100% Anthem fee schedule for outpatient setting,$816.45 ,100% Anthem fee schedule for outpatient setting,$816.45 ,100% Anthem fee schedule for outpatient setting,$816.45 ,100% Anthem fee schedule for outpatient setting,$816.45 ,100% Anthem fee schedule for outpatient setting,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$788.90 ,35% of billed charges for outpatient setting,"$1,758.12 ",78% of billed charges for outpatient setting,"$1,577.80 ",70% of billed charges for outpatient setting,"$1,577.80 ",70% of billed charges for outpatient setting,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,690.50 ",75% of billed charges for outpatient setting,"$1,870.82 ",83% of billed charges for outpatient setting,"$3,606.40 ",100% UHC case rate for outpatient setting,"$3,606.40 ",100% UHC case rate for outpatient setting,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$882.85 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$464.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$464.28 ,"$3,606.40 ","$1,127.00 " Outpatient Medical Services,RADIOLOGY,78264,NM GASTRIC EMPTYING SCA,341,"$1,961.00 ","$1,372.70 ",70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$753.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$753.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$600.87 ,100% Anthem fee schedule for outpatient setting,$600.87 ,100% Anthem fee schedule for outpatient setting,$600.87 ,100% Anthem fee schedule for outpatient setting,$600.87 ,100% Anthem fee schedule for outpatient setting,$600.87 ,100% Anthem fee schedule for outpatient setting,$600.87 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$686.35 ,35% of billed charges for outpatient setting,"$1,529.58 ",78% of billed charges for outpatient setting,"$1,372.70 ",70% of billed charges for outpatient setting,"$1,372.70 ",70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,470.75 ",75% of billed charges for outpatient setting,"$1,627.63 ",83% of billed charges for outpatient setting,"$3,137.60 ",100% UHC case rate for outpatient setting,"$3,137.60 ",100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.08 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,"$3,137.60 ",$980.50 Outpatient Medical Services,RADIOLOGY,78306,NM BONE WHOLE,341,"$1,401.00 ",$980.70 ,70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$537.98 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$537.98 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$528.01 ,100% Anthem fee schedule for outpatient setting,$528.01 ,100% Anthem fee schedule for outpatient setting,$528.01 ,100% Anthem fee schedule for outpatient setting,$528.01 ,100% Anthem fee schedule for outpatient setting,$528.01 ,100% Anthem fee schedule for outpatient setting,$528.01 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.35 ,35% of billed charges for outpatient setting,"$1,092.78 ",78% of billed charges for outpatient setting,$980.70 ,70% of billed charges for outpatient setting,$980.70 ,70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,050.75 ",75% of billed charges for outpatient setting,"$1,162.83 ",83% of billed charges for outpatient setting,"$2,241.60 ",100% UHC case rate for outpatient setting,"$2,241.60 ",100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$548.74 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,"$2,241.60 ",$700.50 Outpatient Medical Services,RADIOLOGY,78315,NM BONE 3 PHASE,341,"$1,820.00 ","$1,274.00 ",70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$698.88 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$698.88 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$599.51 ,100% Anthem fee schedule for outpatient setting,$599.51 ,100% Anthem fee schedule for outpatient setting,$599.51 ,100% Anthem fee schedule for outpatient setting,$599.51 ,100% Anthem fee schedule for outpatient setting,$599.51 ,100% Anthem fee schedule for outpatient setting,$599.51 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$637.00 ,35% of billed charges for outpatient setting,"$1,419.60 ",78% of billed charges for outpatient setting,"$1,274.00 ",70% of billed charges for outpatient setting,"$1,274.00 ",70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,365.00 ",75% of billed charges for outpatient setting,"$1,510.60 ",83% of billed charges for outpatient setting,"$2,912.00 ",100% UHC case rate for outpatient setting,"$2,912.00 ",100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$712.86 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,"$2,912.00 ",$910.00 Outpatient Medical Services,RADIOLOGY,78452,NM MYOCARDIAL/HEART WALL MOTION,341,"$4,727.00 ","$3,308.90 ",70% of total billed charges for outpatient setting,"$1,219.72 ",130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,815.17 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,815.17 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$800.11 ,100% Anthem fee schedule for outpatient setting,$800.11 ,100% Anthem fee schedule for outpatient setting,$800.11 ,100% Anthem fee schedule for outpatient setting,$800.11 ,100% Anthem fee schedule for outpatient setting,$800.11 ,100% Anthem fee schedule for outpatient setting,$800.11 ,100% Anthem fee schedule for outpatient setting,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,654.45 ",35% of billed charges for outpatient setting,"$3,687.06 ",78% of billed charges for outpatient setting,"$3,308.90 ",70% of billed charges for outpatient setting,"$3,308.90 ",70% of billed charges for outpatient setting,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,545.25 ",75% of billed charges for outpatient setting,"$3,923.41 ",83% of billed charges for outpatient setting,"$7,563.20 ",100% UHC case rate for outpatient setting,"$7,563.20 ",100% UHC case rate for outpatient setting,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,851.47 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,"$1,219.72 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$800.11 ,"$7,563.20 ","$2,363.50 " Outpatient Medical Services,RADIOLOGY,78580,NM LUNG PERFUSION,341,$498.00 ,$348.60 ,70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$191.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$191.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$409.33 ,100% Anthem fee schedule for outpatient setting,$409.33 ,100% Anthem fee schedule for outpatient setting,$409.33 ,100% Anthem fee schedule for outpatient setting,$409.33 ,100% Anthem fee schedule for outpatient setting,$409.33 ,100% Anthem fee schedule for outpatient setting,$409.33 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.30 ,35% of billed charges for outpatient setting,$388.44 ,78% of billed charges for outpatient setting,$348.60 ,70% of billed charges for outpatient setting,$348.60 ,70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$373.50 ,75% of billed charges for outpatient setting,$413.34 ,83% of billed charges for outpatient setting,$796.80 ,100% UHC case rate for outpatient setting,$796.80 ,100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$195.05 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.30 ,$796.80 ,$249.00 Outpatient Medical Services,RADIOLOGY,78597,NM QUANTATIVE PUL PERFUSION,341,$498.00 ,$348.60 ,70% of total billed charges for outpatient setting,$354.27 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$191.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$191.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$339.33 ,100% Anthem fee schedule for outpatient setting,$339.33 ,100% Anthem fee schedule for outpatient setting,$339.33 ,100% Anthem fee schedule for outpatient setting,$339.33 ,100% Anthem fee schedule for outpatient setting,$339.33 ,100% Anthem fee schedule for outpatient setting,$339.33 ,100% Anthem fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.30 ,35% of billed charges for outpatient setting,$388.44 ,78% of billed charges for outpatient setting,$348.60 ,70% of billed charges for outpatient setting,$348.60 ,70% of billed charges for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$373.50 ,75% of billed charges for outpatient setting,$413.34 ,83% of billed charges for outpatient setting,$796.80 ,100% UHC case rate for outpatient setting,$796.80 ,100% UHC case rate for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$195.05 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$354.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.30 ,$796.80 ,$249.00 Outpatient Medical Services,RADIOLOGY,A9500,NM MYOVIEW,636,$176.00 ,$123.20 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$67.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$67.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$123.20 ,70% of billed charges for outpatient setting,$123.20 ,70% of billed charges for outpatient setting,$123.20 ,70% of billed charges for outpatient setting,$132.00 ,75% of billed charges for outpatient setting,$123.20 ,70% of billed charges for outpatient setting,$132.00 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$61.60 ,35% of billed charges for outpatient setting,$137.28 ,78% of billed charges for outpatient setting,$123.20 ,70% of billed charges for outpatient setting,$123.20 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$132.00 ,75% of billed charges for outpatient setting,$146.08 ,83% of billed charges for outpatient setting,$88.00 ,50% of billed charges for outpatient setting,$88.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$68.93 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$61.60 ,$146.08 ,$88.00 Outpatient Medical Services,RADIOLOGY,A9500,NM TC 99M SESTAMIBI/CARDIOLITE UP,636,$333.00 ,$233.10 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$127.87 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$127.87 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$233.10 ,70% of billed charges for outpatient setting,$233.10 ,70% of billed charges for outpatient setting,$233.10 ,70% of billed charges for outpatient setting,$249.75 ,75% of billed charges for outpatient setting,$233.10 ,70% of billed charges for outpatient setting,$249.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$116.55 ,35% of billed charges for outpatient setting,$259.74 ,78% of billed charges for outpatient setting,$233.10 ,70% of billed charges for outpatient setting,$233.10 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$249.75 ,75% of billed charges for outpatient setting,$276.39 ,83% of billed charges for outpatient setting,$166.50 ,50% of billed charges for outpatient setting,$166.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$130.43 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$116.55 ,$276.39 ,$166.50 Outpatient Medical Services,RADIOLOGY,A9503,NM TC 99M MDP UP TO 30 MILLICURIE,636,$119.00 ,$83.30 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$45.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$45.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$41.65 ,35% of billed charges for outpatient setting,$92.82 ,78% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,$98.77 ,83% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$46.61 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$41.65 ,$98.77 ,$59.50 Outpatient Medical Services,RADIOLOGY,A9516,NM N417156020105,636,$196.00 ,$137.20 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$75.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$75.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$137.20 ,70% of billed charges for outpatient setting,$137.20 ,70% of billed charges for outpatient setting,$137.20 ,70% of billed charges for outpatient setting,$147.00 ,75% of billed charges for outpatient setting,$137.20 ,70% of billed charges for outpatient setting,$147.00 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$68.60 ,35% of billed charges for outpatient setting,$152.88 ,78% of billed charges for outpatient setting,$137.20 ,70% of billed charges for outpatient setting,$137.20 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$147.00 ,75% of billed charges for outpatient setting,$162.68 ,83% of billed charges for outpatient setting,$98.00 ,50% of billed charges for outpatient setting,$98.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$76.77 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$68.60 ,$162.68 ,$98.00 Outpatient Medical Services,RADIOLOGY,A9537,"NM TC 99M MEBROFENIN/CHOLETEC, UP",636,$195.00 ,$136.50 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$74.88 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$74.88 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$136.50 ,70% of billed charges for outpatient setting,$136.50 ,70% of billed charges for outpatient setting,$136.50 ,70% of billed charges for outpatient setting,$146.25 ,75% of billed charges for outpatient setting,$136.50 ,70% of billed charges for outpatient setting,$146.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$68.25 ,35% of billed charges for outpatient setting,$152.10 ,78% of billed charges for outpatient setting,$136.50 ,70% of billed charges for outpatient setting,$136.50 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$146.25 ,75% of billed charges for outpatient setting,$161.85 ,83% of billed charges for outpatient setting,$97.50 ,50% of billed charges for outpatient setting,$97.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$76.38 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$68.25 ,$161.85 ,$97.50 Outpatient Medical Services,RADIOLOGY,A9540,"NM TC 99M ALBUMIN AGGR/MAA, UP TO",636,$119.00 ,$83.30 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$45.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$45.70 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$41.65 ,35% of billed charges for outpatient setting,$92.82 ,78% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,$83.30 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$89.25 ,75% of billed charges for outpatient setting,$98.77 ,83% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,$59.50 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$46.61 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$41.65 ,$98.77 ,$59.50 Outpatient Medical Services,RADIOLOGY,A9541,"NM TC 99M SULFUR COLLOID, UP TO 2",636,$156.00 ,$109.20 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$59.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$59.90 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$109.20 ,70% of billed charges for outpatient setting,$109.20 ,70% of billed charges for outpatient setting,$109.20 ,70% of billed charges for outpatient setting,$117.00 ,75% of billed charges for outpatient setting,$109.20 ,70% of billed charges for outpatient setting,$117.00 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$54.60 ,35% of billed charges for outpatient setting,$121.68 ,78% of billed charges for outpatient setting,$109.20 ,70% of billed charges for outpatient setting,$109.20 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$117.00 ,75% of billed charges for outpatient setting,$129.48 ,83% of billed charges for outpatient setting,$78.00 ,50% of billed charges for outpatient setting,$78.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$61.10 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$54.60 ,$129.48 ,$78.00 Outpatient Medical Services,RADIOLOGY,71045,XR CHEST PA,320,$64.00 ,$44.80 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$24.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$24.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$20.71 ,100% Anthem fee schedule for outpatient setting,$20.71 ,100% Anthem fee schedule for outpatient setting,$20.71 ,100% Anthem fee schedule for outpatient setting,$20.71 ,100% Anthem fee schedule for outpatient setting,$20.71 ,100% Anthem fee schedule for outpatient setting,$20.71 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.40 ,35% of billed charges for outpatient setting,$49.92 ,78% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$44.80 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,75% of billed charges for outpatient setting,$53.12 ,83% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$32.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.07 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.71 ,$78.05 ,$32.00 Outpatient Medical Services,RADIOLOGY,71046,XR CHEST PA & LATERAL,320,$328.00 ,$229.60 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$125.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$125.95 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$37.86 ,100% Anthem fee schedule for outpatient setting,$37.86 ,100% Anthem fee schedule for outpatient setting,$37.86 ,100% Anthem fee schedule for outpatient setting,$37.86 ,100% Anthem fee schedule for outpatient setting,$37.86 ,100% Anthem fee schedule for outpatient setting,$37.86 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$114.80 ,35% of billed charges for outpatient setting,$255.84 ,78% of billed charges for outpatient setting,$229.60 ,70% of billed charges for outpatient setting,$229.60 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.00 ,75% of billed charges for outpatient setting,$272.24 ,83% of billed charges for outpatient setting,$164.00 ,50% of billed charges for outpatient setting,$164.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$128.47 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.86 ,$272.24 ,$164.00 Outpatient Medical Services,RADIOLOGY,71275,CT CHEST/PE PROTOCOL,320,"$3,035.00 ","$2,124.50 ",70% of total billed charges for outpatient setting,$157.82 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,165.44 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,165.44 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem fee schedule for outpatient setting,$400.00 ,100% Anthem fee schedule for outpatient setting,$400.00 ,100% Anthem fee schedule for outpatient setting,$400.00 ,100% Anthem fee schedule for outpatient setting,$400.00 ,100% Anthem fee schedule for outpatient setting,$400.00 ,100% Anthem fee schedule for outpatient setting,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,062.25 ",35% of billed charges for outpatient setting,"$2,367.30 ",78% of billed charges for outpatient setting,"$2,124.50 ",70% of billed charges for outpatient setting,"$2,124.50 ",70% of billed charges for outpatient setting,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,276.25 ",75% of billed charges for outpatient setting,"$2,519.05 ",83% of billed charges for outpatient setting,"$1,517.50 ",50% of billed charges for outpatient setting,"$1,517.50 ",50% of billed charges for outpatient setting,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,188.75 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$157.82 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.82 ,"$2,519.05 ","$1,517.50 " Outpatient Medical Services,RADIOLOGY,72050,XR CERVICAL SP/OBL,320,$588.00 ,$411.60 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$225.79 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$225.79 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$205.80 ,35% of billed charges for outpatient setting,$458.64 ,78% of billed charges for outpatient setting,$411.60 ,70% of billed charges for outpatient setting,$411.60 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$441.00 ,75% of billed charges for outpatient setting,$488.04 ,83% of billed charges for outpatient setting,$294.00 ,50% of billed charges for outpatient setting,$294.00 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$230.31 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.07 ,$488.04 ,$294.00 Outpatient Medical Services,RADIOLOGY,72072,XR THORACIC SPINE,320,$602.00 ,$421.40 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$231.17 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$231.17 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.70 ,35% of billed charges for outpatient setting,$469.56 ,78% of billed charges for outpatient setting,$421.40 ,70% of billed charges for outpatient setting,$421.40 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$451.50 ,75% of billed charges for outpatient setting,$499.66 ,83% of billed charges for outpatient setting,$301.00 ,50% of billed charges for outpatient setting,$301.00 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$235.79 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.11 ,$499.66 ,$301.00 Outpatient Medical Services,RADIOLOGY,72100,XR LUMBOSACRAL SPINE,320,$497.00 ,$347.90 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$190.85 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$190.85 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$46.11 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$173.95 ,35% of billed charges for outpatient setting,$387.66 ,78% of billed charges for outpatient setting,$347.90 ,70% of billed charges for outpatient setting,$347.90 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$372.75 ,75% of billed charges for outpatient setting,$412.51 ,83% of billed charges for outpatient setting,$248.50 ,50% of billed charges for outpatient setting,$248.50 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$194.67 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.11 ,$412.51 ,$248.50 Outpatient Medical Services,RADIOLOGY,72110,XR LUMBOSACRAL SPINE W/ OBLIQUE,320,$614.00 ,$429.80 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$235.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$235.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$63.94 ,100% Anthem fee schedule for outpatient setting,$63.94 ,100% Anthem fee schedule for outpatient setting,$63.94 ,100% Anthem fee schedule for outpatient setting,$63.94 ,100% Anthem fee schedule for outpatient setting,$63.94 ,100% Anthem fee schedule for outpatient setting,$63.94 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.90 ,35% of billed charges for outpatient setting,$478.92 ,78% of billed charges for outpatient setting,$429.80 ,70% of billed charges for outpatient setting,$429.80 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$460.50 ,75% of billed charges for outpatient setting,$509.62 ,83% of billed charges for outpatient setting,$307.00 ,50% of billed charges for outpatient setting,$307.00 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$240.50 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.94 ,$509.62 ,$307.00 Outpatient Medical Services,RADIOLOGY,73030,XR SHOULDER INT-EXT LEFT,320,$381.00 ,$266.70 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$146.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$146.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.35 ,35% of billed charges for outpatient setting,$297.18 ,78% of billed charges for outpatient setting,$266.70 ,70% of billed charges for outpatient setting,$266.70 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$285.75 ,75% of billed charges for outpatient setting,$316.23 ,83% of billed charges for outpatient setting,$190.50 ,50% of billed charges for outpatient setting,$190.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$149.23 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.56 ,$316.23 ,$190.50 Outpatient Medical Services,RADIOLOGY,73030,XR SHOULDER INT-EXT RIGHT,320,$383.00 ,$268.10 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$147.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$147.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$38.56 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.05 ,35% of billed charges for outpatient setting,$298.74 ,78% of billed charges for outpatient setting,$268.10 ,70% of billed charges for outpatient setting,$268.10 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$287.25 ,75% of billed charges for outpatient setting,$317.89 ,83% of billed charges for outpatient setting,$191.50 ,50% of billed charges for outpatient setting,$191.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$150.01 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.56 ,$317.89 ,$191.50 Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW 3 VIEWS RIGHT,320,$373.00 ,$261.10 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$143.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$143.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$130.55 ,35% of billed charges for outpatient setting,$290.94 ,78% of billed charges for outpatient setting,$261.10 ,70% of billed charges for outpatient setting,$261.10 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$279.75 ,75% of billed charges for outpatient setting,$309.59 ,83% of billed charges for outpatient setting,$186.50 ,50% of billed charges for outpatient setting,$186.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.09 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.05 ,$309.59 ,$186.50 Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW 3 VIEWS LEFT,320,$336.00 ,$235.20 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$129.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$129.02 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.60 ,35% of billed charges for outpatient setting,$262.08 ,78% of billed charges for outpatient setting,$235.20 ,70% of billed charges for outpatient setting,$235.20 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.00 ,75% of billed charges for outpatient setting,$278.88 ,83% of billed charges for outpatient setting,$168.00 ,50% of billed charges for outpatient setting,$168.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$131.60 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.05 ,$278.88 ,$168.00 Outpatient Medical Services,RADIOLOGY,73110,XR WRIST W OBLIQUES RIGHT,320,$381.00 ,$266.70 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$146.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$146.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.35 ,35% of billed charges for outpatient setting,$297.18 ,78% of billed charges for outpatient setting,$266.70 ,70% of billed charges for outpatient setting,$266.70 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$285.75 ,75% of billed charges for outpatient setting,$316.23 ,83% of billed charges for outpatient setting,$190.50 ,50% of billed charges for outpatient setting,$190.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$149.23 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.90 ,$316.23 ,$190.50 Outpatient Medical Services,RADIOLOGY,73110,XR WRIST W OBLIQUES LEFT,320,$392.00 ,$274.40 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$150.53 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$150.53 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.20 ,35% of billed charges for outpatient setting,$305.76 ,78% of billed charges for outpatient setting,$274.40 ,70% of billed charges for outpatient setting,$274.40 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$294.00 ,75% of billed charges for outpatient setting,$325.36 ,83% of billed charges for outpatient setting,$196.00 ,50% of billed charges for outpatient setting,$196.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$153.54 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.90 ,$325.36 ,$196.00 Outpatient Medical Services,RADIOLOGY,73130,XR HAND RIGHT,320,$380.00 ,$266.00 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$145.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$145.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.00 ,35% of billed charges for outpatient setting,$296.40 ,78% of billed charges for outpatient setting,$266.00 ,70% of billed charges for outpatient setting,$266.00 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$285.00 ,75% of billed charges for outpatient setting,$315.40 ,83% of billed charges for outpatient setting,$190.00 ,50% of billed charges for outpatient setting,$190.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.84 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.73 ,$315.40 ,$190.00 Outpatient Medical Services,RADIOLOGY,73130,XR HAND LEFT,320,$332.00 ,$232.40 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$127.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$127.49 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$44.73 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.20 ,35% of billed charges for outpatient setting,$258.96 ,78% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$232.40 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.00 ,75% of billed charges for outpatient setting,$275.56 ,83% of billed charges for outpatient setting,$166.00 ,50% of billed charges for outpatient setting,$166.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$130.04 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.73 ,$275.56 ,$166.00 Outpatient Medical Services,RADIOLOGY,73502,XR HIP AP UNILATERAL RIGHT,320,$310.00 ,$217.00 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$119.04 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$119.04 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$108.50 ,35% of billed charges for outpatient setting,$241.80 ,78% of billed charges for outpatient setting,$217.00 ,70% of billed charges for outpatient setting,$217.00 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$232.50 ,75% of billed charges for outpatient setting,$257.30 ,83% of billed charges for outpatient setting,$155.00 ,50% of billed charges for outpatient setting,$155.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$121.42 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.45 ,$257.30 ,$155.00 Outpatient Medical Services,RADIOLOGY,73502,XR HIP AP UNILATERAL LEFT,320,$313.00 ,$219.10 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$120.19 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$120.19 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$58.45 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$109.55 ,35% of billed charges for outpatient setting,$244.14 ,78% of billed charges for outpatient setting,$219.10 ,70% of billed charges for outpatient setting,$219.10 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$234.75 ,75% of billed charges for outpatient setting,$259.79 ,83% of billed charges for outpatient setting,$156.50 ,50% of billed charges for outpatient setting,$156.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$122.59 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.45 ,$259.79 ,$156.50 Outpatient Medical Services,RADIOLOGY,73523,XR HIP AP LAT & PELVIS BILATERAL,320,$833.00 ,$583.10 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$319.87 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$319.87 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$78.36 ,100% Anthem fee schedule for outpatient setting,$78.36 ,100% Anthem fee schedule for outpatient setting,$78.36 ,100% Anthem fee schedule for outpatient setting,$78.36 ,100% Anthem fee schedule for outpatient setting,$78.36 ,100% Anthem fee schedule for outpatient setting,$78.36 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$291.55 ,35% of billed charges for outpatient setting,$649.74 ,78% of billed charges for outpatient setting,$583.10 ,70% of billed charges for outpatient setting,$583.10 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$624.75 ,75% of billed charges for outpatient setting,$691.39 ,83% of billed charges for outpatient setting,$416.50 ,50% of billed charges for outpatient setting,$416.50 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$326.27 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.36 ,$691.39 ,$416.50 Outpatient Medical Services,RADIOLOGY,73562,XR KNEE 3 VIEWS RIGHT,320,$385.00 ,$269.50 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$147.84 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$147.84 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.75 ,35% of billed charges for outpatient setting,$300.30 ,78% of billed charges for outpatient setting,$269.50 ,70% of billed charges for outpatient setting,$269.50 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$288.75 ,75% of billed charges for outpatient setting,$319.55 ,83% of billed charges for outpatient setting,$192.50 ,50% of billed charges for outpatient setting,$192.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$150.80 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.90 ,$319.55 ,$192.50 Outpatient Medical Services,RADIOLOGY,73562,XR KNEE 3 VIEWS LEFT,320,$378.00 ,$264.60 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$145.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$145.15 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$50.90 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.30 ,35% of billed charges for outpatient setting,$294.84 ,78% of billed charges for outpatient setting,$264.60 ,70% of billed charges for outpatient setting,$264.60 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$283.50 ,75% of billed charges for outpatient setting,$313.74 ,83% of billed charges for outpatient setting,$189.00 ,50% of billed charges for outpatient setting,$189.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.05 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.90 ,$313.74 ,$189.00 Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE 3 VIEWS RIGHT,320,$383.00 ,$268.10 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$147.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$147.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$134.05 ,35% of billed charges for outpatient setting,$298.74 ,78% of billed charges for outpatient setting,$268.10 ,70% of billed charges for outpatient setting,$268.10 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$287.25 ,75% of billed charges for outpatient setting,$317.89 ,83% of billed charges for outpatient setting,$191.50 ,50% of billed charges for outpatient setting,$191.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$150.01 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.05 ,$317.89 ,$191.50 Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE 3 VIEWS LEFT,320,$373.00 ,$261.10 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$143.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$143.23 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$44.05 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$130.55 ,35% of billed charges for outpatient setting,$290.94 ,78% of billed charges for outpatient setting,$261.10 ,70% of billed charges for outpatient setting,$261.10 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$279.75 ,75% of billed charges for outpatient setting,$309.59 ,83% of billed charges for outpatient setting,$186.50 ,50% of billed charges for outpatient setting,$186.50 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.09 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.05 ,$309.59 ,$186.50 Outpatient Medical Services,RADIOLOGY,73630,XR FOOT RIGHT,320,$380.00 ,$266.00 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$145.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$145.92 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.00 ,35% of billed charges for outpatient setting,$296.40 ,78% of billed charges for outpatient setting,$266.00 ,70% of billed charges for outpatient setting,$266.00 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$285.00 ,75% of billed charges for outpatient setting,$315.40 ,83% of billed charges for outpatient setting,$190.00 ,50% of billed charges for outpatient setting,$190.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.84 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.62 ,$315.40 ,$190.00 Outpatient Medical Services,RADIOLOGY,73630,XR FOOT LEFT,320,$382.00 ,$267.40 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$146.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$146.69 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$40.62 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.70 ,35% of billed charges for outpatient setting,$297.96 ,78% of billed charges for outpatient setting,$267.40 ,70% of billed charges for outpatient setting,$267.40 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$286.50 ,75% of billed charges for outpatient setting,$317.06 ,83% of billed charges for outpatient setting,$191.00 ,50% of billed charges for outpatient setting,$191.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$149.62 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.62 ,$317.06 ,$191.00 Outpatient Medical Services,RADIOLOGY,74018,XR ABDOMEN FLAT/KUB,320,$240.00 ,$168.00 ,70% of total billed charges for outpatient setting,$78.05 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$92.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$92.16 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$35.13 ,100% Anthem fee schedule for outpatient setting,$35.13 ,100% Anthem fee schedule for outpatient setting,$35.13 ,100% Anthem fee schedule for outpatient setting,$35.13 ,100% Anthem fee schedule for outpatient setting,$35.13 ,100% Anthem fee schedule for outpatient setting,$35.13 ,100% Anthem fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.00 ,35% of billed charges for outpatient setting,$187.20 ,78% of billed charges for outpatient setting,$168.00 ,70% of billed charges for outpatient setting,$168.00 ,70% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$180.00 ,75% of billed charges for outpatient setting,$199.20 ,83% of billed charges for outpatient setting,$120.00 ,50% of billed charges for outpatient setting,$120.00 ,50% of billed charges for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.00 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$78.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.13 ,$199.20 ,$120.00 Outpatient Medical Services,RADIOLOGY,74019,XR ABD FLAT/UPRIGHT,320,$98.00 ,$68.60 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$37.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$37.63 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$41.98 ,100% Anthem fee schedule for outpatient setting,$41.98 ,100% Anthem fee schedule for outpatient setting,$41.98 ,100% Anthem fee schedule for outpatient setting,$41.98 ,100% Anthem fee schedule for outpatient setting,$41.98 ,100% Anthem fee schedule for outpatient setting,$41.98 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.30 ,35% of billed charges for outpatient setting,$76.44 ,78% of billed charges for outpatient setting,$68.60 ,70% of billed charges for outpatient setting,$68.60 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.50 ,75% of billed charges for outpatient setting,$81.34 ,83% of billed charges for outpatient setting,$49.00 ,50% of billed charges for outpatient setting,$49.00 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.38 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.30 ,$94.43 ,$49.00 Outpatient Medical Services,RADIOLOGY,76000,RF FLUORO UNDER 1 HOUR,320,"$1,054.00 ",$737.80 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$404.74 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$404.74 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$75.60 ,100% Anthem fee schedule for outpatient setting,$75.60 ,100% Anthem fee schedule for outpatient setting,$75.60 ,100% Anthem fee schedule for outpatient setting,$75.60 ,100% Anthem fee schedule for outpatient setting,$75.60 ,100% Anthem fee schedule for outpatient setting,$75.60 ,100% Anthem fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$368.90 ,35% of billed charges for outpatient setting,$822.12 ,78% of billed charges for outpatient setting,$737.80 ,70% of billed charges for outpatient setting,$737.80 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$790.50 ,75% of billed charges for outpatient setting,$874.82 ,83% of billed charges for outpatient setting,$527.00 ,50% of billed charges for outpatient setting,$527.00 ,50% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.83 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.60 ,$874.82 ,$527.00 Outpatient Medical Services,RADIOLOGY,77080,DX DUAL BONE DENSITY ST,320,$452.00 ,$316.40 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$173.57 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$173.57 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$61.88 ,100% Anthem fee schedule for outpatient setting,$61.88 ,100% Anthem fee schedule for outpatient setting,$61.88 ,100% Anthem fee schedule for outpatient setting,$61.88 ,100% Anthem fee schedule for outpatient setting,$61.88 ,100% Anthem fee schedule for outpatient setting,$61.88 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.20 ,35% of billed charges for outpatient setting,$352.56 ,78% of billed charges for outpatient setting,$316.40 ,70% of billed charges for outpatient setting,$316.40 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$339.00 ,75% of billed charges for outpatient setting,$375.16 ,83% of billed charges for outpatient setting,$226.00 ,50% of billed charges for outpatient setting,$226.00 ,50% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.04 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.88 ,$375.16 ,$226.00 Outpatient Medical Services,RADIOLOGY,74176,CT ABDOMEN/PELVIS W/O CONTRAST,350,"$3,540.00 ","$2,478.00 ",70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$1,359.36 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$1,359.36 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,239.00 ",35% of billed charges for outpatient setting,"$2,761.20 ",78% of billed charges for outpatient setting,"$2,478.00 ",70% of billed charges for outpatient setting,"$2,478.00 ",70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,655.00 ",75% of billed charges for outpatient setting,"$2,938.20 ",83% of billed charges for outpatient setting,"$5,664.00 ",100% UHC case rate for outpatient setting,"$5,664.00 ",100% UHC case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,386.55 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,"$5,664.00 ","$1,770.00 " Outpatient Medical Services,RADIOLOGY,74177,CT ABDOMEN/PELVIS W/CONTRAST,350,"$6,542.00 ","$4,579.40 ",70% of total billed charges for outpatient setting,$330.34 ,130% CMS Medicare OPPS fee schedule for outpatient setting,"$2,512.13 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,"$2,512.13 ",38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,289.70 ",35% of billed charges for outpatient setting,"$5,102.76 ",78% of billed charges for outpatient setting,"$4,579.40 ",70% of billed charges for outpatient setting,"$4,579.40 ",70% of billed charges for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,906.50 ",75% of billed charges for outpatient setting,"$5,429.86 ",83% of billed charges for outpatient setting,"$10,467.20 ",100% UHC case rate for outpatient setting,"$10,467.20 ",100% UHC case rate for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,562.37 ",39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$330.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.34 ,"$10,467.20 ","$3,271.00 " Outpatient Medical Services,RADIOLOGY,70450,CT BRAIN W/O CONTRAST,351,$375.00 ,$262.50 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$144.00 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$144.00 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$131.25 ,35% of billed charges for outpatient setting,$292.50 ,78% of billed charges for outpatient setting,$262.50 ,70% of billed charges for outpatient setting,$262.50 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$281.25 ,75% of billed charges for outpatient setting,$311.25 ,83% of billed charges for outpatient setting,$600.00 ,100% UHC case rate for outpatient setting,$600.00 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.88 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$600.00 ,$187.50 Outpatient Medical Services,RADIOLOGY,70486,CT FACIAL W/O CON,351,$439.00 ,$307.30 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$168.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$168.58 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$153.65 ,35% of billed charges for outpatient setting,$342.42 ,78% of billed charges for outpatient setting,$307.30 ,70% of billed charges for outpatient setting,$307.30 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$329.25 ,75% of billed charges for outpatient setting,$364.37 ,83% of billed charges for outpatient setting,$702.40 ,100% UHC case rate for outpatient setting,$702.40 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$171.95 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$702.40 ,$219.50 Outpatient Medical Services,RADIOLOGY,71250,CT CHEST W/O CONTRA,352,$418.00 ,$292.60 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$160.51 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$160.51 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.30 ,35% of billed charges for outpatient setting,$326.04 ,78% of billed charges for outpatient setting,$292.60 ,70% of billed charges for outpatient setting,$292.60 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$313.50 ,75% of billed charges for outpatient setting,$346.94 ,83% of billed charges for outpatient setting,$668.80 ,100% UHC case rate for outpatient setting,$668.80 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$163.72 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$668.80 ,$209.00 Outpatient Medical Services,RADIOLOGY,72125,CT CERVICAL SP 5-7 W/O CONTRAS,352,$506.00 ,$354.20 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$194.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$194.30 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$177.10 ,35% of billed charges for outpatient setting,$394.68 ,78% of billed charges for outpatient setting,$354.20 ,70% of billed charges for outpatient setting,$354.20 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$379.50 ,75% of billed charges for outpatient setting,$419.98 ,83% of billed charges for outpatient setting,$809.60 ,100% UHC case rate for outpatient setting,$809.60 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$198.19 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$809.60 ,$253.00 Outpatient Medical Services,RADIOLOGY,72131,CT LUMBAR SPINE W/O CONTRAST,352,$521.00 ,$364.70 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$200.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$200.06 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$400.00 ,100% Anthem CT case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$182.35 ,35% of billed charges for outpatient setting,$406.38 ,78% of billed charges for outpatient setting,$364.70 ,70% of billed charges for outpatient setting,$364.70 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$390.75 ,75% of billed charges for outpatient setting,$432.43 ,83% of billed charges for outpatient setting,$833.60 ,100% UHC case rate for outpatient setting,$833.60 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$204.06 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$833.60 ,$260.50 Outpatient Medical Services,RADIOLOGY,77061,MM TOMO DIAGNOSTIC UNILATERAL MAMMO,401,$258.00 ,$180.60 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$99.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$99.07 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$180.60 ,70% of billed charges for outpatient setting,$180.60 ,70% of billed charges for outpatient setting,$180.60 ,70% of billed charges for outpatient setting,$193.50 ,75% of billed charges for outpatient setting,$180.60 ,70% of billed charges for outpatient setting,$193.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$90.30 ,35% of billed charges for outpatient setting,$201.24 ,78% of billed charges for outpatient setting,$180.60 ,70% of billed charges for outpatient setting,$180.60 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$193.50 ,75% of billed charges for outpatient setting,$214.14 ,83% of billed charges for outpatient setting,$412.80 ,100% UHC case rate for outpatient setting,$412.80 ,100% UHC case rate for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$101.05 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$90.30 ,$412.80 ,$129.00 Outpatient Medical Services,RADIOLOGY,77062,MM TOMO DIAGNOSTIC BILATERAL MAMMO,401,$317.00 ,$221.90 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$121.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$121.73 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$221.90 ,70% of billed charges for outpatient setting,$221.90 ,70% of billed charges for outpatient setting,$221.90 ,70% of billed charges for outpatient setting,$237.75 ,75% of billed charges for outpatient setting,$221.90 ,70% of billed charges for outpatient setting,$237.75 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$110.95 ,35% of billed charges for outpatient setting,$247.26 ,78% of billed charges for outpatient setting,$221.90 ,70% of billed charges for outpatient setting,$221.90 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$237.75 ,75% of billed charges for outpatient setting,$263.11 ,83% of billed charges for outpatient setting,$507.20 ,100% UHC case rate for outpatient setting,$507.20 ,100% UHC case rate for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$124.16 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$110.95 ,$507.20 ,$158.50 Outpatient Medical Services,RADIOLOGY,77066,MM DIAGNOSTIC MAMMO/CAD BILATERAL,401,$245.00 ,$171.50 ,70% of total billed charges for outpatient setting,$97.30 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$94.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$94.08 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$234.09 ,100% Anthem fee schedule for outpatient setting,$234.09 ,100% Anthem fee schedule for outpatient setting,$234.09 ,100% Anthem fee schedule for outpatient setting,$234.09 ,100% Anthem fee schedule for outpatient setting,$234.09 ,100% Anthem fee schedule for outpatient setting,$234.09 ,100% Anthem fee schedule for outpatient setting,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.75 ,35% of billed charges for outpatient setting,$191.10 ,78% of billed charges for outpatient setting,$171.50 ,70% of billed charges for outpatient setting,$171.50 ,70% of billed charges for outpatient setting,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$183.75 ,75% of billed charges for outpatient setting,$203.35 ,83% of billed charges for outpatient setting,$392.00 ,100% UHC case rate for outpatient setting,$392.00 ,100% UHC case rate for outpatient setting,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.96 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$97.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$85.75 ,$392.00 ,$122.50 Outpatient Medical Services,RADIOLOGY,76536,US THYROID,402,$311.00 ,$217.70 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$119.42 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$119.42 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$173.03 ,100% Anthem fee schedule for outpatient setting,$173.03 ,100% Anthem fee schedule for outpatient setting,$173.03 ,100% Anthem fee schedule for outpatient setting,$173.03 ,100% Anthem fee schedule for outpatient setting,$173.03 ,100% Anthem fee schedule for outpatient setting,$173.03 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$108.85 ,35% of billed charges for outpatient setting,$242.58 ,78% of billed charges for outpatient setting,$217.70 ,70% of billed charges for outpatient setting,$217.70 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$233.25 ,75% of billed charges for outpatient setting,$258.13 ,83% of billed charges for outpatient setting,$497.60 ,100% UHC case rate for outpatient setting,$497.60 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$121.81 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$497.60 ,$155.50 Outpatient Medical Services,RADIOLOGY,76641,US BREAST UNILAT LT,402,$601.00 ,$420.70 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$230.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$230.78 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.35 ,35% of billed charges for outpatient setting,$468.78 ,78% of billed charges for outpatient setting,$420.70 ,70% of billed charges for outpatient setting,$420.70 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$450.75 ,75% of billed charges for outpatient setting,$498.83 ,83% of billed charges for outpatient setting,$961.60 ,100% UHC case rate for outpatient setting,$961.60 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$235.40 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$961.60 ,$300.50 Outpatient Medical Services,RADIOLOGY,76641,US BREAST UNILAT RT,402,$612.00 ,$428.40 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$235.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$235.01 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$138.73 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.20 ,35% of billed charges for outpatient setting,$477.36 ,78% of billed charges for outpatient setting,$428.40 ,70% of billed charges for outpatient setting,$428.40 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.00 ,75% of billed charges for outpatient setting,$507.96 ,83% of billed charges for outpatient setting,$979.20 ,100% UHC case rate for outpatient setting,$979.20 ,100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$239.71 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,$979.20 ,$306.00 Outpatient Medical Services,RADIOLOGY,76705,US ABD (SPECIFY OR,402,$895.00 ,$626.50 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$343.68 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$343.68 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$121.58 ,100% Anthem fee schedule for outpatient setting,$121.58 ,100% Anthem fee schedule for outpatient setting,$121.58 ,100% Anthem fee schedule for outpatient setting,$121.58 ,100% Anthem fee schedule for outpatient setting,$121.58 ,100% Anthem fee schedule for outpatient setting,$121.58 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$313.25 ,35% of billed charges for outpatient setting,$698.10 ,78% of billed charges for outpatient setting,$626.50 ,70% of billed charges for outpatient setting,$626.50 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$671.25 ,75% of billed charges for outpatient setting,$742.85 ,83% of billed charges for outpatient setting,"$1,432.00 ",100% UHC case rate for outpatient setting,"$1,432.00 ",100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$350.55 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,"$1,432.00 ",$447.50 Outpatient Medical Services,RADIOLOGY,76775,US RENAL,402,$782.00 ,$547.40 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$300.29 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$300.29 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$57.07 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$273.70 ,35% of billed charges for outpatient setting,$609.96 ,78% of billed charges for outpatient setting,$547.40 ,70% of billed charges for outpatient setting,$547.40 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$586.50 ,75% of billed charges for outpatient setting,$649.06 ,83% of billed charges for outpatient setting,"$1,251.20 ",100% UHC case rate for outpatient setting,"$1,251.20 ",100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$306.30 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.07 ,"$1,251.20 ",$391.00 Outpatient Medical Services,RADIOLOGY,76830,US TRANSVAGINAL,402,$890.00 ,$623.00 ,70% of total billed charges for outpatient setting,$94.43 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$341.76 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$341.76 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$170.98 ,100% Anthem fee schedule for outpatient setting,$170.98 ,100% Anthem fee schedule for outpatient setting,$170.98 ,100% Anthem fee schedule for outpatient setting,$170.98 ,100% Anthem fee schedule for outpatient setting,$170.98 ,100% Anthem fee schedule for outpatient setting,$170.98 ,100% Anthem fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$311.50 ,35% of billed charges for outpatient setting,$694.20 ,78% of billed charges for outpatient setting,$623.00 ,70% of billed charges for outpatient setting,$623.00 ,70% of billed charges for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$667.50 ,75% of billed charges for outpatient setting,$738.70 ,83% of billed charges for outpatient setting,"$1,424.00 ",100% UHC case rate for outpatient setting,"$1,424.00 ",100% UHC case rate for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$348.60 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$94.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.43 ,"$1,424.00 ",$445.00 Outpatient Medical Services,RADIOLOGY,77063,MM TOMO SCREENING MAMMO BILATERAL,403,$84.00 ,$58.80 ,70% of total billed charges for outpatient setting,$20.81 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$32.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$32.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$48.72 ,100% Anthem fee schedule for outpatient setting,$48.72 ,100% Anthem fee schedule for outpatient setting,$48.72 ,100% Anthem fee schedule for outpatient setting,$48.72 ,100% Anthem fee schedule for outpatient setting,$48.72 ,100% Anthem fee schedule for outpatient setting,$48.72 ,100% Anthem fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.40 ,35% of billed charges for outpatient setting,$65.52 ,78% of billed charges for outpatient setting,$58.80 ,70% of billed charges for outpatient setting,$58.80 ,70% of billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.00 ,75% of billed charges for outpatient setting,$69.72 ,83% of billed charges for outpatient setting,$134.40 ,100% UHC case rate for outpatient setting,$134.40 ,100% UHC case rate for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.91 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,$134.40 ,$42.00 Outpatient Medical Services,RADIOLOGY,77067,MM DIGITAL SCREENING MAMMO/CAD BILATERAL,403,$209.00 ,$146.30 ,70% of total billed charges for outpatient setting,$80.16 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$80.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$80.26 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$193.62 ,100% Anthem fee schedule for outpatient setting,$193.62 ,100% Anthem fee schedule for outpatient setting,$193.62 ,100% Anthem fee schedule for outpatient setting,$193.62 ,100% Anthem fee schedule for outpatient setting,$193.62 ,100% Anthem fee schedule for outpatient setting,$193.62 ,100% Anthem fee schedule for outpatient setting,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.15 ,35% of billed charges for outpatient setting,$163.02 ,78% of billed charges for outpatient setting,$146.30 ,70% of billed charges for outpatient setting,$146.30 ,70% of billed charges for outpatient setting,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$156.75 ,75% of billed charges for outpatient setting,$173.47 ,83% of billed charges for outpatient setting,$334.40 ,100% UHC case rate for outpatient setting,$334.40 ,100% UHC case rate for outpatient setting,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.87 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$80.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.15 ,$334.40 ,$104.50 Outpatient Medical Services,RADIOLOGY,Q9967,CONTRAST OPTIRAY 300,636,$2.00 ,$1.40 ,70% of total billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.77 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$0.77 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.70 ,35% of billed charges for outpatient setting,$1.56 ,78% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,$1.40 ,70% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$1.50 ,75% of billed charges for outpatient setting,$1.66 ,83% of billed charges for outpatient setting,$1.00 ,50% of billed charges for outpatient setting,$1.00 ,50% of billed charges for outpatient setting,N/A,Not separately reimbursable for outpatient setting,N/A,Not separately reimbursable for outpatient setting,$0.79 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,N/A,Not separately reimbursable for outpatient setting,$0.70 ,$1.66 ,$1.00 Outpatient Medical Services,RADIOLOGY,93880,US CAROTID DUPLEX DOPPL,921,$467.00 ,$326.90 ,70% of total billed charges for outpatient setting,$210.48 ,130% CMS Medicare OPPS fee schedule for outpatient setting,$179.33 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$179.33 ,38.4% of total billed charges which is 100% of the GA Medicaid outpatient rate,$320.67 ,100% Anthem fee schedule for outpatient setting,$320.67 ,100% Anthem fee schedule for outpatient setting,$320.67 ,100% Anthem fee schedule for outpatient setting,$320.67 ,100% Anthem fee schedule for outpatient setting,$320.67 ,100% Anthem fee schedule for outpatient setting,$320.67 ,100% Anthem fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$163.45 ,35% of billed charges for outpatient setting,$364.26 ,78% of billed charges for outpatient setting,$326.90 ,70% of billed charges for outpatient setting,$326.90 ,70% of billed charges for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$350.25 ,75% of billed charges for outpatient setting,$387.61 ,83% of billed charges for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$212.00 ,100% UHC case rate for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$182.92 ,39.17% of total billed charges which is 102% of the GA Medicaid outpatient rate,$210.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$163.45 ,$387.61 ,$233.50 Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99243,"Patient office consultation, typically 40 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99244,"Patient office consultation, typically 60 min",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,LAB,80069,Kidney function panel tes,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,76805,"Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus",402,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,RADIOLOGY,19120,"Removal of 1 or more breast growth, open procedure",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,29826,Shaving of shoulder bone using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,29881,Removal of one knee cartilage using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,45391,Ultrasound examination of lower large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,OUTPATIENT SERVICES,66984,Removal of cataract with insertion of lens,360,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,ECCG,93000,"Electrocardiogram, routine, with interpretation and report",730,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,Service not offered,N/A,N/A,N/A