CMS Mandated Shoppable Services

Macon Community Hospital
Last Updated: 03/23/2026
ITEM_SERVICE	LINE	REV_CODE	HCPCS	DESCRIPTION	Patient Type	CHARGES	Self Pay	Aetna Commercial	BlueCare Tennessee Medicaid	Blue Cross Network P	Blue Cross Network S	CIGNA	Humana Commercial	Wellpoint Medicare Advantage	Blue Cross Medicare Advantage	Cigna Healthspring Medicare Advantage	Farm Bureau Medicare Advantage	Humana Medicare Advantage	United Helthcare Medicare Advantage	Wellcare Medicare Advantage	PHCS	TRICARE	United Healthcare Commercial	United Healthcare Tenncare Medicaid	VA Community Care Network	Wellpoint Tenncare Medicaid	De-identified minimum	De-identified maximum
11406	1	1		EXCISE BENIGN LESION > 4 CM ARM LEG TRUNK	OUT	5130.34	3078.2	4360.79	662.97	2573	2367	752	4104.27	2975.6	2975.6	2975.6	2975.6	2975.6	2975.6	2975.6	4617.31	1382.46	4617.31	694	2975.6	2975.6	662.97	4617.31
11406	2	250		PHARMACY		256.93
11406	3	258		IV SOLUTIONS		83.25
11406	4	270		MED / SUR SUPPLIES & DEVICES		311.13
11406	5	272		MED / SUR - STERILE SUPPLY		99.53
11406	6	310	88305	LAB - PATHOLOGICAL		387.7
11406	7	360	11406	OR SERVICES		3520
11406	8	370		ANESTHESIA		135.65
11406	9	710		RECOVERY ROOM - GENERAL		336.15
11406	10
11642	1	1		EXCISE MALIGNANT LESION 1.1-2 CM FACE EAR NOSE LIP	OUT	2360.34	1416.2	2006.29	495.2	2310	2125	561	1888.27	1369	1369	1369	1369	1369	1369	1369	2124.31	636.04	2124.31	347	1369	1369	347	2310
11642	2	250		PHARMACY		256.93
11642	3	258		IV SOLUTIONS		83.25
11642	4	270		MED / SUR SUPPLIES & DEVICES		311.13
11642	5	272		MED / SUR - STERILE SUPPLY		99.53
11642	6	310	88305	LAB - PATHOLOGICAL		387.7
11642	7	360	11642	OR SERVICES		750
11642	8	370		ANESTHESIA		135.65
11642	9	710		RECOVERY ROOM - GENERAL		336.15
11642	10
19120	1	1		REMOVAL OF 1 OR MORE BREAST GROWTH OPEN PROCEDURE	OUT	10614.24	6368.54	9022.1	761.74	3019	2777	860	8491.39	6156.26	6156.26	6156.26	6156.26	6156.26	6156.26	6156.26	9552.82	2860.2	9552.82	818	6156.26	6156.26	761.74	9552.82
19120	2	250		PHARMACY		256.93
19120	3	258		IV SOLUTIONS		83.25
19120	4	270		MED / SUR SUPPLIES & DEVICES		311.13
19120	5	272		MED / SUR - STERILE SUPPLY		99.53
19120	6	307	81025	LAB - UROLOGY		51.7
19120	7	310	88305	LAB - PATHOLOGICAL		387.7
19120	8	360	19120	OR SERVICES		8600
19120	9	370		ANESTHESIA		135.65
19120	10	402	76642	OTHER IMAGING - ULTRASOUND		352.2
19120	11	710		RECOVERY ROOM - GENERAL		336.15
19120	12
19301	1	1		MASTECTOMY PARTIAL LUMPECTOMY	OUT	15022.64	9013.58	12769.24	1340.83	4305.5	3960.5	1680	12018.11	4356.57	4356.57	4356.57	4356.57	4356.57	4356.57	4356.57	13520.38	4048.12	13520.38	1227	4356.57	4356.57	1227	13520.38
19301	2	250		PHARMACY		256.93
19301	3	258		IV SOLUTIONS		83.25
19301	4	270		MED / SUR SUPPLIES & DEVICES		311.13
19301	5	272		MED / SUR - STERILE SUPPLY		99.53
19301	6	360	19301	OR SERVICES		13800
19301	7	360	38525	OR SERVICES		0
19301	8	360	38900	OR SERVICES		0
19301	9	370		ANESTHESIA		135.65
19301	10	710		RECOVERY ROOM - GENERAL		336.15
19301	11
29826	1	1		ARTHROSCOPY SHOULDER W BONE SHAVING NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
29826	2
29881	1	1		ARTHROSCOPY KNEE MENISCECTOMY NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
29881	2
42820	1	1		REMOVE TONSILS/ADENOID PT < 12 YRS NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
42820	2
43235	1	1		DIAG EXAM ESOPHAGUS/STOMACH/UPPER BOWEL ENDOSCOPE	OUT	2382.69	1429.61	2025.29	495.2	2310	2125	561	1906.15	690.98	690.98	690.98	690.98	690.98	690.98	690.98	2144.42	642.06	2144.42	694	690.98	690.98	495.2	2310
43235	2	250		PHARMACY		256.93
43235	3	258		IV SOLUTIONS		83.25
43235	4	370		ANESTHESIA		135.65
43235	5	710		RECOVERY ROOM - GENERAL		336.15
43235	6	750	43235	GASTROINTESTINAL SERVICES - GENERAL		1570.71
43235	7
43239	1	1		BIOPSY ESOPHAGUS/STOMACH/SM BOWEL WITH ENDOSCOPE	OUT	3429.61	2057.77	2915.17	662.97	2573	2367	752	2743.69	994.59	994.59	994.59	994.59	994.59	994.59	994.59	3086.65	924.17	3086.65	694	994.59	994.59	662.97	3086.65
43239	2	250		PHARMACY		256.93
43239	3	258		IV SOLUTIONS		83.25
43239	4	370		ANESTHESIA		135.65
43239	5	710		RECOVERY ROOM - GENERAL		336.15
43239	6	750	43239	GASTROINTESTINAL SERVICES - GENERAL		2617.63
43239	7
43450	1	1		UPPER GI ENDOSCOPE W BIOPSY AND DILATION ESOPHAGUS	OUT	6915.73	4149.44	5878.37	910.57	3728	3429.5	1032.5	5532.58	4011.12	4011.12	4011.12	4011.12	4011.12	4011.12	4011.12	6224.16	1863.57	6224.16	1041	4011.12	4011.12	910.57	6224.16
43450	2	250		PHARMACY		256.93
43450	3	258		IV SOLUTIONS		83.25
43450	4	310	88305	LAB - PATHOLOGICAL		387.7
43450	5	310	88312	LAB - PATHOLOGICAL		591.4
43450	6	370		ANESTHESIA		135.65
43450	7	710		RECOVERY ROOM - GENERAL		336.15
43450	8	750	43239	GASTROINTESTINAL SERVICES - GENERAL		2617.63
43450	9	750	43450	GASTROINTESTINAL SERVICES - GENERAL		2507.02
43450	10
45331	1	1		FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY(IES)	OUT	5032.58	3019.55	4277.69	9.57	2310	2125	561	4026.06	2918.9	2918.9	2918.9	2918.9	2918.9	2918.9	2918.9	4529.32	1356.12	4529.32	347	2918.9	2918.9	9.57	4529.32
45331	2	250		PHARMACY		256.93
45331	3	258		IV SOLUTIONS		83.25
45331	4	310	88304	LAB - PATHOLOGICAL		320.6
45331	5	370		ANESTHESIA		135.65
45331	6	710		RECOVERY ROOM - GENERAL		336.15
45331	7	750	45331	GASTROINTESTINAL SERVICES - GENERAL		3900
45331	8
45378	1	1		DIAGNOSTIC EXAM OF LARGE BOWEL USING AN ENDOSCOPE	OUT	2307.01	1384.21	1960.96	662.97	2307.01	2307.01	752	1845.61	669.03	669.03	669.03	669.03	669.03	669.03	669.03	2076.31	621.67	2076.31	694	669.03	669.03	621.67	2307.01
45378	2	250		PHARMACY		256.93
45378	3	258		IV SOLUTIONS		83.25
45378	4	370		ANESTHESIA		135.65
45378	5	710		RECOVERY ROOM - GENERAL		336.15
45378	6	750	45378	GASTROINTESTINAL SERVICES - GENERAL		1495.03
45378	7
45380	1	1		SIGMOIDOSCOPY FLEXIBLE DIAGNOSTIC INCL SPECIMEN(S)	OUT	3813.51	2288.11	3241.48	662.97	2573	2367	752	3050.81	2211.84	2211.84	2211.84	2211.84	2211.84	2211.84	2211.84	3432.16	1027.62	3432.16	694	2211.84	2211.84	662.97	3432.16
45380	2	250		PHARMACY		256.93
45380	3	258		IV SOLUTIONS		83.25
45380	4	310	88305	LAB - PATHOLOGICAL		387.7
45380	5	370		ANESTHESIA		135.65
45380	6	710		RECOVERY ROOM - GENERAL		336.15
45380	7	750	45380	GASTROINTESTINAL SERVICES - GENERAL		2613.83
45380	8
45385	1	1		REMOVE POLYPS/GROWTHS LARGE BOWEL USING ENDOSCOPE	OUT	4590.26	2754.16	3901.72	662.97	2573	2367	752	3672.21	2662.35	2662.35	2662.35	2662.35	2662.35	2662.35	2662.35	4131.23	1236.93	4131.23	694	2662.35	2662.35	662.97	4131.23
45385	2	250		PHARMACY		256.93
45385	3	258		IV SOLUTIONS		83.25
45385	4	310	88305	LAB - PATHOLOGICAL		387.7
45385	5	370		ANESTHESIA		135.65
45385	6	710		RECOVERY ROOM - GENERAL		336.15
45385	7	750	45385	GASTROINTESTINAL SERVICES - GENERAL		3390.58
45385	8
45391	1	1		ULTRASOUND LOWER LG BOWEL ENDOSCOPE NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
45391	2
46221	1	1		HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS	OUT	8743.24	5245.94	7431.75	761.74	3019	2777	561	6994.59	5071.08	5071.08	5071.08	5071.08	5071.08	5071.08	5071.08	7868.92	2356.02	7868.92	347	5071.08	5071.08	347	7868.92
46221	2	250		PHARMACY		256.93
46221	3	258		IV SOLUTIONS		83.25
46221	4	270		MED / SUR SUPPLIES & DEVICES		311.13
46221	5	272		MED / SUR - STERILE SUPPLY		99.53
46221	6	310	88304	LAB - PATHOLOGICAL		320.6
46221	7	360	46221	OR SERVICES		7200
46221	8	370		ANESTHESIA		135.65
46221	9	710		RECOVERY ROOM - GENERAL		336.15
46221	10
47562	1	1		REMOVE GALLBLADDER USING AN ENDOSCOPE	OUT	12243.24	7345.94	10406.75	3247.2	7350	6762	3000	9794.59	7101.08	7101.08	7101.08	7101.08	7101.08	7101.08	7101.08	11018.92	3299.16	11018.92	2995	7101.08	7101.08	2995	11018.92
47562	2	250		PHARMACY		256.93
47562	3	258		IV SOLUTIONS		83.25
47562	4	270		MED / SUR SUPPLIES & DEVICES		311.13
47562	5	272		MED / SUR - STERILE SUPPLY		99.53
47562	6	310	88304	LAB - PATHOLOGICAL		320.6
47562	7	360	47562	OR SERVICES		10700
47562	8	370		ANESTHESIA		135.65
47562	9	710		RECOVERY ROOM - GENERAL		336.15
47562	10
49505	1	1		REPAIR GROIN HERNIA PATIENT AGE 5 YEARS OR OLDER	OUT	10000.84	6000.5	8500.71	936.28	3675	3381	1062	8000.67	5800.49	5800.49	5800.49	5800.49	5800.49	5800.49	5800.49	9000.76	2694.91	9000.76	1332	5800.49	5800.49	936.28	9000.76
49505	2	250		PHARMACY		256.93
49505	3	258		IV SOLUTIONS		83.25
49505	4	270		MED / SUR SUPPLIES & DEVICES		311.13
49505	5	272		MED / SUR - STERILE SUPPLY		99.53
49505	6	360	49505	OR SERVICES		8600
49505	7	370		ANESTHESIA		135.65
49505	8	710		RECOVERY ROOM - GENERAL		336.15
49505	9	730	93005	EKG / ECG		178.2
49505	10
49591	1	1		REPAIR ABDOMINAL HERNIA(S) <3 CM REDUCIBLE	OUT	9822.64	5893.58	8349.24	936.28	3675	3381	1062	7858.11	2848.57	2848.57	2848.57	2848.57	2848.57	2848.57	2848.57	8840.38	2646.89	8840.38	1332	2848.57	2848.57	936.28	8840.38
49591	2	250		PHARMACY		256.93
49591	3	258		IV SOLUTIONS		83.25
49591	4	270		MED / SUR SUPPLIES & DEVICES		311.13
49591	5	272		MED / SUR - STERILE SUPPLY		99.53
49591	6	360	49591	OR SERVICES		8600
49591	7	370		ANESTHESIA		135.65
49591	8	710		RECOVERY ROOM - GENERAL		336.15
49591	9
55700	1	1		BIOPSY OF PROSTATE GLAND NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
55700	2
55866	1	1		REMOVE PROSTATE/LYMPH NODE ENDOSCOPE NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
55866	2
59400	1	1		ROUTINE OB CARE FOR VAGINAL DELIVERY NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
59400	2
59510	1	1		ROUTINE OB CARE FOR C-SECTION NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
59510	2
59610	1	1		ROUTINE OB VAGINAL DEL AFTER C-SECT NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
59610	2
62322	1	1		INJECT SPINE LOW BACK NO IMAGING NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
62322	2
62323	1	1		INJECT SPINE LOW BACK IMAGE GUIDE NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
62323	2
64483	1	1		INJECT DRUG SACRAL SPINE IMAGE GUIDE NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
64483	2
66821	1	1		REMOVE RECURRING CATARACT W LASER NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
66821	2
66984	1	1		REMOVAL OF CATARACT WITH LENS INSERTION	OUT	7928.74	4757.24	6739.43	1572.19	6825	6279	1654	6342.99	2299.33	2299.33	2299.33	2299.33	2299.33	2299.33	2299.33	7135.87	2136.54	7135.87	818	2299.33	2299.33	818	7135.87
66984	2	250		PHARMACY		256.93
66984	3	276		MED / SUR - INTRAOCULAR LENSES		0.01
66984	4	360	66984	OR SERVICES		7200
66984	5	370		ANESTHESIA		135.65
66984	6	710		RECOVERY ROOM - GENERAL		336.15
66984	7
70140	1	1		X-RAY FACIAL BONES LESS THAN 3 VIEWS	OUT	264.2	158.52	224.57	17.71	39.13	36.04	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	17.71	237.78
70140	2	320	70140	RADIOLOGY - GENERAL		264.2
70140	3
70150	1	1		X-RAY FACIAL BONES COMPLETE SERIES	OUT	319	191.4	271.15	22.35	58.5	53.88	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	22.35	287.1
70150	2	320	70150	RADIOLOGY - GENERAL		319
70150	3
70160	1	1		X-RAY NASAL BONES COMPLETE SERIES	OUT	264.2	158.52	224.57	15.04	49.51	45.6	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.04	237.78
70160	2	320	70160	RADIOLOGY - GENERAL		264.2
70160	3
70220	1	1		X-RAY OF SINUSES PARANASAL COMPLETE	OUT	264.2	158.52	224.57	22.35	51.58	47.5	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	31.88	153.24	153.24	22.35	237.78
70220	2	320	70220	RADIOLOGY - GENERAL		264.2
70220	3
70250	1	1		X-RAY OF SKULL < 4 VIEWS	OUT	319	191.4	271.15	17.71	48.83	44.97	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	17.71	287.1
70250	2	320	70250	RADIOLOGY - GENERAL		319
70250	3
70360	1	1		X-RAY SOFT TISSUE OF NECK	OUT	264.2	158.52	224.57	11.95	40.53	37.32	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	11.95	237.78
70360	2	320	70360	RADIOLOGY - GENERAL		264.2
70360	3
70450	1	1		CT SCAN HEAD OR BRAIN WITHOUT CONTRAST	OUT	425.4	255.24	361.59	133.73	158.09	145.59	368	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	78.11	246.73	246.73	78.11	382.86
70450	2	350	70450	CT SCAN - GENERAL		425.4
70450	3
70470	1	1		CT SCAN HEAD OR BRAIN WITH AND WITHOUT CONTRAST	OUT	712.1	427.26	605.29	200.25	270.84	249.42	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	148.2	413.02	413.02	148.2	640.89
70470	2	350	70470	CT SCAN - GENERAL		712.1
70470	3
70480	1	1		CT SCAN ORBIT FACE AND NECK WITHOUT CONTRAST	OUT	574.7	344.82	488.5	133.73	363.5	334.76	368	459.76	333.33	333.33	333.33	333.33	333.33	333.33	333.33	517.23	154.86	517.23	78.11	333.33	333.33	78.11	517.23
70480	2	350	70480	CT SCAN - GENERAL		574.7
70480	3
70486	1	1		CT SCAN MAXILLOFACIAL INCLUDE SINUSES WO CONTRAST	OUT	461.3	276.78	392.11	133.73	290.9	267.89	368	369.04	267.55	267.55	267.55	267.55	267.55	267.55	267.55	415.17	124.31	415.17	78.11	267.55	267.55	78.11	415.17
70486	2	350	70486	CT SCAN - GENERAL		461.3
70486	3
70490	1	1		CT SCAN SOFT TISSUE NECK WITHOUT CONTRAST	OUT	543.8	326.28	462.23	133.73	272.9	251.32	368	435.04	315.4	315.4	315.4	315.4	315.4	315.4	315.4	489.42	146.54	489.42	78.11	315.4	315.4	78.11	489.42
70490	2	350	70490	CT SCAN - GENERAL		543.8
70490	3
70491	1	1		CT SCAN SOFT TISSUE NECK WITH CONTRAST	OUT	712.1	427.26	605.29	160.16	342.75	315.65	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	133.72	413.02	413.02	133.72	640.89
70491	2	350	70491	CT SCAN - GENERAL		712.1
70491	3
70492	1	1		CT SCAN SOFT TISSUE NECK WITH AND WITHOUT CONTRAST	OUT	796.8	478.08	677.28	200.25	425.76	392.1	368	637.44	462.14	462.14	462.14	462.14	462.14	462.14	462.14	717.12	214.71	717.12	148.2	462.14	462.14	148.2	717.12
70492	2	350	70492	CT SCAN - GENERAL		796.8
70492	3
70496/70498	1	1		CT ANGIOGRAPHY OF THE HEAD AND NECK WITH CONTRAST	OUT	1885	1131	1602.25	409.26	1430.4	1317.29	736	1508	1093.3	1093.3	1093.3	1093.3	1093.3	1093.3	1093.3	1696.5	507.95	1696.5	305.32	1093.3	1093.3	305.32	1696.5
70496/70498	2	351	70496	CT SCAN - HEAD SCAN		942.5
70496/70498	3	351	70498	CT SCAN - HEAD SCAN		942.5
70496/70498	4
70540	1	1		MRI SCAN OF SOFT TISSUE NECK WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	571.69	526.48	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
70540	2	614	70540	MRI - OTHER		1208.6
70540	3
70543	1	1		MRI ORBIT FACE NECK WITH AND WITHOUT CONTRAST	OUT	1785.7	1071.42	1517.85	703.69	775.03	713.75	650	1428.56	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1607.13	481.19	1607.13	247.26	1035.71	1035.71	247.26	1607.13
70543	2	614	70543	MRI - OTHER		1785.7
70543	3
70544	1	1		MR ANGIOGRAPHY OF THE HEAD WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	320.06	671.29	618.22	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
70544	2	615	70544	MRA - HEAD AND NECK		1208.6
70544	3
70551	1	1		MRI SCAN OF BRAIN STEM WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	332.39	306.11	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
70551	2	611	70551	MRI - BRAIN		1208.6
70551	3
70553	1	1		MRI SCAN OF BRAIN WITH AND WITHOUT CONTRAST	OUT	1785.7	1071.42	1517.85	704.92	541.26	498.47	650	1428.56	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1607.13	481.19	1607.13	247.26	1035.71	1035.71	247.26	1607.13
70553	2	611	70553	MRI - BRAIN		1785.7
70553	3
71045	1	1		X-RAY EXAM OF CHEST- SINGLE VIEW	OUT	264.2	158.52	224.57	7.8	20.64	19.01	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.95	153.24	153.24	7.8	237.78
71045	2	320	71045	RADIOLOGY - GENERAL		264.2
71045	3
71046	1	1		X-RAY EXAM OF CHEST- TWO VIEWS	OUT	264.2	158.52	224.57	14.38	38.06	35.05	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.95	153.24	153.24	14.38	237.78
71046	2	320	71046	RADIOLOGY - GENERAL		264.2
71046	3
71100	1	1		X-RAY EXAM OF RIBS (UNILATERAL) 2 VIEWS	OUT	264.2	158.52	224.57	16.3	42.59	39.22	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	16.3	237.78
71100	2	320	71100	RADIOLOGY - GENERAL		264.2
71100	3
71101	1	1		X-RAY EXAM OF RIBS (UNILATERAL) WITH CHEST 3 VIEWS	OUT	319	191.4	271.15	19.13	52.27	48.13	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	19.13	287.1
71101	2	320	71101	RADIOLOGY - GENERAL		319
71101	3
71250	1	1		CT SCAN THORAX WITHOUT CONTRAST (NON-CARDIAC)	OUT	481.3	288.78	409.11	167.06	272.9	251.32	368	385.04	279.15	279.15	279.15	279.15	279.15	279.15	279.15	433.17	129.69	433.17	78.11	279.15	279.15	78.11	433.17
71250	2	350	71250	CT SCAN - GENERAL		481.3
71250	3
71260	1	1		CT SCAN THORAX WITH CONTRAST (NON-CARDIAC)	OUT	712.1	427.26	605.29	200.25	344.15	316.94	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	133.72	413.02	413.02	133.72	640.89
71260	2	350	71260	CT SCAN - GENERAL		712.1
71260	3
71270	1	1		CT SCAN THORAX WITH/WITHOUT CONTRAST (NON-CARDIAC)	OUT	712.1	427.26	605.29	250.31	427.83	394	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	148.2	413.02	413.02	148.2	640.89
71270	2	350	71270	CT SCAN - GENERAL		712.1
71270	3
71271	1	1		CT SCAN THORAX LOW DOSE FOR LUNG CANCER SCREENING	OUT	425.4	255.24	361.59	70.69	187.07	172.28	368	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	36.41	246.73	246.73	36.41	382.86
71271	2	350	71271	CT SCAN - GENERAL		425.4
71271	3
71275	1	1		CT ANGIOGRAPHY OF CHEST (NON-CARDIAC)	OUT	712.1	427.26	605.29	251.3	539.18	496.54	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	152.66	413.02	413.02	152.66	640.89
71275	2	350	71275	CT SCAN - GENERAL		712.1
71275	3
72040	1	1		X-RAY CERVICAL SPINE 2 OR 3 VIEWS	OUT	264.2	158.52	224.57	17.15	47.43	43.68	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	17.15	237.78
72040	2	320	72040	RADIOLOGY - GENERAL		264.2
72040	3
72050	1	1		X-RAY CERVICAL SPINE 4 OR 5 VIEWS	OUT	319	191.4	271.15	25.31	64.03	58.96	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	25.31	287.1
72050	2	320	72050	RADIOLOGY - GENERAL		319
72050	3
72072	1	1		X-RAY OF THORACIC SPINE 3 VIEWS	OUT	319	191.4	271.15	20.94	52.27	48.13	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	20.94	287.1
72072	2	320	72072	RADIOLOGY - GENERAL		319
72072	3
72082	1	1		X-RAY ENTIRE SPINE (THORACIC/LUMBAR/CERVICAL/SACR)	OUT	319	191.4	271.15	33.59	88.88	81.85	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	45.31	185.02	185.02	33.59	287.1
72082	2	320	72082	RADIOLOGY - GENERAL		319
72082	3
72100	1	1		X-RAY LOWER SPINE (LUMBAR/SACRAL) 2-3 VIEWS	OUT	319	191.4	271.15	19.13	47.43	43.68	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	19.13	287.1
72100	2	320	72100	RADIOLOGY - GENERAL		319
72100	3
72100/72200	1	1		X-RAY LOWER SPINE 2-3 VIEWS AND SACROILIAC JOINTS	OUT	638	382.8	542.3	34.17	88.65	81.64	391.74	510.4	370.04	370.04	370.04	370.04	370.04	370.04	370.04	574.2	171.92	574.2	41.36	370.04	370.04	34.17	574.2
72100/72200	2	320	72100	RADIOLOGY - GENERAL		319
72100/72200	3	320	72200	RADIOLOGY - GENERAL		319
72100/72200	4
72110	1	1		X-RAY SPINE LUMBOSACRAL 4+ VIEWS	OUT	319	191.4	271.15	25.87	65.42	60.25	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	25.87	287.1
72110	2	320	72110	RADIOLOGY - GENERAL		319
72110	3
72114	1	1		X-RAY SPINE LUMBOSACRAL WITH BENDING 6+ VIEWS	OUT	319	191.4	271.15	33.33	93.07	85.71	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	31.88	287.1
72114	2	320	72114	RADIOLOGY - GENERAL		319
72114	3
72120	1	1		X-RAY SPINE LUMBOSACRAL WITH BENDING 2-3 VIEWS	OUT	319	191.4	271.15	25.31	56.42	51.96	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	25.31	287.1
72120	2	320	72120	RADIOLOGY - GENERAL		319
72120	3
72125	1	1		CT SCAN CERVICAL SPINE WITHOUT CONTRAST	OUT	470.3	282.18	399.76	167.06	276.36	254.51	368	376.24	272.77	272.77	272.77	272.77	272.77	272.77	272.77	423.27	126.73	423.27	78.11	272.77	272.77	78.11	423.27
72125	2	350	72125	CT SCAN - GENERAL		470.3
72125	3
72128	1	1		CT SCAN THORACIC SPINE WITHOUT CONTRAST	OUT	469.1	281.46	398.74	167.06	274.99	253.24	368	375.28	272.08	272.08	272.08	272.08	272.08	272.08	272.08	422.19	126.41	422.19	78.11	272.08	272.08	78.11	422.19
72128	2	350	72128	CT SCAN - GENERAL		469.1
72128	3
72131	1	1		CT SCAN LUMBAR SPINE WITHOUT CONTRAST	OUT	468	280.8	397.8	167.06	273.59	251.96	368	374.4	271.44	271.44	271.44	271.44	271.44	271.44	271.44	421.2	126.11	421.2	78.11	271.44	271.44	78.11	421.2
72131	2	350	72131	CT SCAN - GENERAL		468
72131	3
72133	1	1		CT SCAN LUMBAR SPINE WITH AND WITHOUT CONTRAST	OUT	712.1	427.26	605.29	250.31	431.29	397.19	368	569.68	413.02	413.02	413.02	413.02	413.02	413.02	413.02	640.89	191.89	640.89	148.2	413.02	413.02	148.2	640.89
72133	2	350	72133	CT SCAN - GENERAL		712.1
72133	3
72141	1	1		MRI SCAN CERVICAL SPINAL CANAL WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	327.55	301.65	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
72141	2	612	72141	MRI - SPINAL CORD		1208.6
72141	3
72146	1	1		MRI SCAN THORACIC SPINAL CANAL WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	352.4	327.55	301.65	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
72146	2	612	72146	MRI - SPINAL CORD		1208.6
72146	3
72148	1	1		MRI SCAN LUMBAR SPINE WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	352.4	327.55	301.65	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
72148	2	612	72148	MRI - SPINAL CORD		1208.6
72148	3
72158	1	1		MRI LUMBAR SPINAL CANAL W AND WITHOUT CONTRAST	OUT	1785.7	1071.42	1517.85	704.92	538.49	495.91	650	1428.56	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1607.13	481.19	1607.13	247.26	1035.71	1035.71	247.26	1607.13
72158	2	612	72158	MRI - SPINAL CORD		1785.7
72158	3
72170	1	1		X-RAY PELVIS 1-2 VIEWS	OUT	319	191.4	271.15	15.04	38.44	35.4	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	15.04	287.1
72170	2	320	72170	RADIOLOGY - GENERAL		319
72170	3
72192	1	1		CT SCAN PELVIS WITHOUT CONTRAST	OUT	721.4	432.84	613.19	167.06	187.85	172.99	368	577.12	418.41	418.41	418.41	418.41	418.41	418.41	418.41	649.26	194.39	649.26	78.11	418.41	418.41	78.11	649.26
72192	2	350	72192	CT SCAN - GENERAL		721.4
72192	3
72193	1	1		CT SCAN PELVIS WITH CONTRAST	OUT	812.3	487.38	690.46	193.78	344.15	316.94	368	649.84	471.13	471.13	471.13	471.13	471.13	471.13	471.13	731.07	218.89	731.07	133.72	471.13	471.13	133.72	731.07
72193	2	350	72193	CT SCAN - GENERAL		812.3
72193	3
72194	1	1		CT SCAN PELVIS WITH AND WITHOUT CONTRAST	OUT	849.1	509.46	721.74	240.46	417.47	384.46	368	679.28	492.48	492.48	492.48	492.48	492.48	492.48	492.48	764.19	228.81	764.19	148.2	492.48	492.48	148.2	764.19
72194	2	350	72194	CT SCAN - GENERAL		849.1
72194	3
72195	1	1		MRI SCAN PELVIS WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.94	591.74	544.96	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
72195	2	614	72195	MRI - OTHER		1208.6
72195	3
72202	1	1		X-RAY SACROILIAC JOINTS 3+ VIEWS	OUT	319	191.4	271.15	17.71	50.2	46.23	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	17.71	287.1
72202	2	320	72202	RADIOLOGY - GENERAL		319
72202	3
72220	1	1		X-RAY SACRUM AND COCCYX 2+ VIEWS	OUT	264.2	158.52	224.57	16.3	39.82	36.67	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	16.3	237.78
72220	2	320	72220	RADIOLOGY - GENERAL		264.2
72220	3
73000	1	1		X-RAY CLAVICLE COMPLETE	OUT	396.2	237.72	336.77	15.04	40.53	37.32	243.27	316.96	229.8	229.8	229.8	229.8	229.8	229.8	229.8	356.58	106.76	356.58	20.68	229.8	229.8	15.04	356.58
73000	2	320	73000	RADIOLOGY - GENERAL		396.2
73000	3
73010	1	1		X-RAY SCAPULA COMPLETE	OUT	319	191.4	271.15	15.04	43.97	40.49	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	15.04	287.1
73010	2	320	73010	RADIOLOGY - GENERAL		319
73010	3
73020	1	1		X-RAY SHOULDER 1 VIEW	OUT	396.2	237.72	336.77	13.64	31.52	29.03	243.27	316.96	229.8	229.8	229.8	229.8	229.8	229.8	229.8	356.58	106.76	356.58	20.68	229.8	229.8	13.64	356.58
73020	2	320	73020	RADIOLOGY - GENERAL		396.2
73020	3
73030	1	1		X-RAY SHOULDER COMPLETE 2 VIEWS	OUT	264.2	158.52	224.57	16.3	41.22	37.96	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	16.3	237.78
73030	2	320	73030	RADIOLOGY - GENERAL		264.2
73030	3
73060	1	1		X-RAY UPPER ARM (HUMERUS) 2+ VIEWS	OUT	264.2	158.52	224.57	16.3	39.82	36.67	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	16.3	237.78
73060	2	320	73060	RADIOLOGY - GENERAL		264.2
73060	3
73070	1	1		X-RAY ELBOW 2 VIEWS	OUT	264.2	158.52	224.57	15.04	39.82	36.67	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.04	237.78
73070	2	320	73070	RADIOLOGY - GENERAL		264.2
73070	3
73080	1	1		X-RAY ELBOW COMPLETE 3+ VIEWS	OUT	396.2	237.72	336.77	16.3	48.83	44.97	243.27	316.96	229.8	229.8	229.8	229.8	229.8	229.8	229.8	356.58	106.76	356.58	20.68	229.8	229.8	16.3	356.58
73080	2	320	73080	RADIOLOGY - GENERAL		396.2
73080	3
73090	1	1		X-RAY FOREARM (RADIUS/ULNA) 2 VIEWS	OUT	264.2	158.52	224.57	15.04	38.44	35.4	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.04	237.78
73090	2	320	73090	RADIOLOGY - GENERAL		264.2
73090	3
73100	1	1		X-RAY WRIST 2 VIEWS	OUT	264.2	158.52	224.57	14.21	43.97	40.49	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	14.21	237.78
73100	2	320	73100	RADIOLOGY - GENERAL		264.2
73100	3
73110	1	1		X-RAY WRIST COMPLETE 3+ VIEWS	OUT	264.2	158.52	224.57	15.33	57.13	52.61	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.33	237.78
73110	2	320	73110	RADIOLOGY - GENERAL		264.2
73110	3
73120	1	1		X-RAY HAND 2 VIEWS	OUT	319	191.4	271.15	14.21	37.75	34.77	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	14.21	287.1
73120	2	320	73120	RADIOLOGY - GENERAL		319
73120	3
73130	1	1		X-RAY HAND 3+ VIEWS	OUT	264.2	158.52	224.57	15.33	47.43	43.68	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.33	237.78
73130	2	320	73130	RADIOLOGY - GENERAL		264.2
73130	3
73140	1	1		X-RAY FINGER 2+ VIEWS	OUT	264.2	158.52	224.57	11.95	51.58	47.5	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	11.95	237.78
73140	2	320	73140	RADIOLOGY - GENERAL		264.2
73140	3
73200	1	1		CT SCAN ELBOW WITHOUT CONTRAST	OUT	554.4	332.64	471.24	140.34	272.9	251.32	368	443.52	321.55	321.55	321.55	321.55	321.55	321.55	321.55	498.96	149.39	498.96	78.11	321.55	321.55	78.11	498.96
73200	2	350	73200	CT SCAN - GENERAL		554.4
73200	3
73218	1	1		MRI SCAN OF ARM (NON-JOINT) WITHOUT CONTRAST	OUT	1345	807	1143.25	317.04	583.45	537.31	650	1076	780.1	780.1	780.1	780.1	780.1	780.1	780.1	1210.5	362.43	1210.5	152.32	780.1	780.1	152.32	1210.5
73218	2	614	73218	MRI - OTHER		1345
73218	3
73220	1	1		MRI SCAN OF ARM (NON-JOINT) WITH AND WOUT CONTRAST	OUT	1823.3	1093.98	1549.81	317.38	788.17	725.85	650	1458.64	1057.51	1057.51	1057.51	1057.51	1057.51	1057.51	1057.51	1640.97	491.32	1640.97	247.26	1057.51	1057.51	247.26	1640.97
73220	2	614	73220	MRI - OTHER		1823.3
73220	3
73221	1	1		MRI SCAN OF ARM JOINT WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	360.75	332.22	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
73221	2	614	73221	MRI - OTHER		1208.6
73221	3
73501	1	1		X-RAY HIP UNILATERAL WITH PELVIS 1 VIEW	OUT	264.2	158.52	224.57	14.52	38.42	35.38	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.36	153.24	153.24	14.52	237.78
73501	2	320	73501	RADIOLOGY - GENERAL		264.2
73501	3
73502	1	1		X-RAY HIP UNILATERAL WITH 2-3 VIEWS OF PELVIS	OUT	264.2	158.52	224.57	21.83	57.77	53.2	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.36	153.24	153.24	21.83	237.78
73502	2	320	73502	RADIOLOGY - GENERAL		264.2
73502	3
73503	1	1		X-RAY HIP UNILATERAL WITH 4+ VIEWS OF PELVIS	OUT	319	191.4	271.15	27.05	71.6	65.93	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	45.31	185.02	185.02	27.05	287.1
73503	2	320	73503	RADIOLOGY - GENERAL		319
73503	3
73521	1	1		X-RAY HIP BILATERAL WITH PELVIS 2 VIEWS	OUT	478.5	287.1	406.73	20.26	53.62	49.38	293.8	382.8	277.53	277.53	277.53	277.53	277.53	277.53	277.53	430.65	128.94	430.65	45.31	277.53	277.53	20.26	430.65
73521	2	320	73521	RADIOLOGY - GENERAL		478.5
73521	3
73522	1	1		X-RAY HIP BILATERAL WITH PELVIS 3-4 VIEWS	OUT	478.5	287.1	406.73	24.45	64.69	59.58	293.8	382.8	277.53	277.53	277.53	277.53	277.53	277.53	277.53	430.65	128.94	430.65	45.31	277.53	277.53	24.45	430.65
73522	2	320	73522	RADIOLOGY - GENERAL		478.5
73522	3
73523	1	1		X-RAY HIP BILATERAL WITH PELVIS 5+ VIEWS	OUT	478.5	287.1	406.73	29.41	77.83	71.68	293.8	382.8	138.77	138.77	138.77	138.77	138.77	138.77	138.77	430.65	128.94	430.65	86.39	138.77	138.77	29.41	430.65
73523	2	320	73523	RADIOLOGY - GENERAL		478.5
73523	3
73552	1	1		X-RAY FEMUR 2 VIEWS	OUT	264.2	158.52	224.57	16.61	43.95	40.47	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.36	153.24	153.24	16.61	237.78
73552	2	320	73552	RADIOLOGY - GENERAL		264.2
73552	3
73560	1	1		X-RAY OF KNEE 1-2 VIEWS	OUT	264.2	158.52	224.57	15.04	41.9	38.59	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.04	237.78
73560	2	320	73560	RADIOLOGY - GENERAL		264.2
73560	3
73562	1	1		X-RAY OF KNEE 3 VIEWS	OUT	264.2	158.52	224.57	16.3	53.66	49.42	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	16.3	237.78
73562	2	320	73562	RADIOLOGY - GENERAL		264.2
73562	3
73564	1	1		X-RAY OF KNEE COMPLETE 4 OR MORE VIEWS	OUT	319	191.4	271.15	17.71	61.96	57.06	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	17.71	287.1
73564	2	320	73564	RADIOLOGY - GENERAL		319
73564	3
73590	1	1		X-RAY TIBIA/FIBULA 2 VIEWS	OUT	264.2	158.52	224.57	15.04	37.07	34.14	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.04	237.78
73590	2	320	73590	RADIOLOGY - GENERAL		264.2
73590	3
73600	1	1		X-RAY ANKLE 2 VIEWS	OUT	264.2	158.52	224.57	14.21	39.82	36.67	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	14.21	237.78
73600	2	320	73600	RADIOLOGY - GENERAL		264.2
73600	3
73610	1	1		X-RAY ANKLE 3 VIEWS	OUT	264.2	158.52	224.57	15.33	48.83	44.97	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.33	237.78
73610	2	320	73610	RADIOLOGY - GENERAL		264.2
73610	3
73620	1	1		X-RAY FOOT 2 VIEWS	OUT	264.2	158.52	224.57	14.21	38.44	35.4	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	14.21	237.78
73620	2	320	73620	RADIOLOGY - GENERAL		264.2
73620	3
73630	1	1		X-RAY FOOT COMPLETE 3 VIEWS	OUT	264.2	158.52	224.57	15.33	45.37	41.78	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	15.33	237.78
73630	2	320	73630	RADIOLOGY - GENERAL		264.2
73630	3
73650	1	1		X-RAY HEEL (CALCANEUS) 2 VIEWS	OUT	264.2	158.52	224.57	13.64	39.82	36.67	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	13.64	237.78
73650	2	320	73650	RADIOLOGY - GENERAL		264.2
73650	3
73660	1	1		X-RAY TOE 2 VIEWS	OUT	264.2	158.52	224.57	11.95	46.74	43.05	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	20.68	153.24	153.24	11.95	237.78
73660	2	320	73660	RADIOLOGY - GENERAL		264.2
73660	3
73700	1	1		CT SCAN ANKLE WITHOUT CONTRAST	OUT	469.1	281.46	398.74	140.34	272.9	251.32	368	375.28	272.08	272.08	272.08	272.08	272.08	272.08	272.08	422.19	126.41	422.19	78.11	272.08	272.08	78.11	422.19
73700	2	350	73700	CT SCAN - GENERAL		469.1
73700	3
73718	1	1		MRI OF LEG (NON-JOINT) WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.04	583.45	537.31	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
73718	2	614	73718	MRI - OTHER		1208.6
73718	3
73721	1	1		MRI SCAN LEG JOINT WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	361.44	332.86	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
73721	2	614	73721	MRI - OTHER		1208.6
73721	3
74018	1	1		X-RAY OF ABDOMEN 1 VIEW	OUT	264.2	158.52	224.57	13.33	35.28	32.49	162.22	211.36	153.24	153.24	153.24	153.24	153.24	153.24	153.24	237.78	71.19	237.78	27.95	153.24	153.24	13.33	237.78
74018	2	320	74018	RADIOLOGY - GENERAL		264.2
74018	3
74019	1	1		X-RAY OF ABDOMEN 2 VIEWS	OUT	319	191.4	271.15	15.96	42.25	38.91	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	51.51	185.02	185.02	15.96	287.1
74019	2	320	74019	RADIOLOGY - GENERAL		319
74019	3
74022	1	1		X-RAY OF ABDOMEN COMPLETE SERIES WITH CHEST	OUT	319	191.4	271.15	20.94	65.42	60.25	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	31.88	185.02	185.02	20.94	287.1
74022	2	320	74022	RADIOLOGY - GENERAL		319
74022	3
74150	1	1		CT SCAN OF ABDOMEN WITHOUT CONTRAST	OUT	494.4	296.64	420.24	160.16	183.7	169.17	368	395.52	286.75	286.75	286.75	286.75	286.75	286.75	286.75	444.96	133.22	444.96	78.11	286.75	286.75	78.11	444.96
74150	2	350	74150	CT SCAN - GENERAL		494.4
74150	3
74160	1	1		CT SCAN OF ABDOMEN WITH CONTRAST	OUT	827.3	496.38	703.21	193.78	342.75	315.65	368	661.84	479.83	479.83	479.83	479.83	479.83	479.83	479.83	744.57	222.93	744.57	133.72	479.83	479.83	133.72	744.57
74160	2	350	74160	CT SCAN - GENERAL		827.3
74160	3
74170	1	1		CT SCAN OF ABDOMEN WITH AND WITHOUT CONTRAST	OUT	880	528	748	240.46	402.93	371.07	368	704	510.4	510.4	510.4	510.4	510.4	510.4	510.4	792	237.13	792	148.2	510.4	510.4	148.2	792
74170	2	350	74170	CT SCAN - GENERAL		880
74170	3
74174	1	1		CT ANGIOGRAM ABDOMEN PELVIS W AND WITHOUT CONTRAST	OUT	1428.5	857.1	1214.23	333.14	842.8	776.16	368	1142.8	828.53	828.53	828.53	828.53	828.53	828.53	828.53	1285.65	384.94	1285.65	217.16	828.53	828.53	217.16	1285.65
74174	2	352	74174	CT SCAN - BODY SCAN		1428.5
74174	3
74175	1	1		CT ANGIOGRAM ABDOMEN WITH CONTRAST	OUT	953.4	572.04	810.39	241.52	566.85	522.03	368	762.72	552.97	552.97	552.97	552.97	552.97	552.97	552.97	858.06	256.91	858.06	152.66	552.97	552.97	152.66	858.06
74175	2	352	74175	CT SCAN - BODY SCAN		953.4
74175	3
74176	1	1		CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST	OUT	966.9	580.14	821.87	101.11	250.78	230.95	368	773.52	560.8	560.8	560.8	560.8	560.8	560.8	560.8	870.21	260.55	870.21	137.72	560.8	560.8	101.11	870.21
74176	2	350	74176	CT SCAN - GENERAL		966.9
74176	3
74177	1	1		CT SCAN ABDOMEN AND PELVIS WITH CONTRAST	OUT	1428.5	857.1	1214.23	192.93	452.73	416.93	368	1142.8	828.53	828.53	828.53	828.53	828.53	828.53	828.53	1285.65	384.94	1285.65	217.16	828.53	828.53	192.93	1285.65
74177	2	350	74177	CT SCAN - GENERAL		1428.5
74177	3
74178	1	1		CT SCAN ABDOMEN/PELVIS WITH AND WITHOUT CONTRAST	OUT	1428.5	857.1	1214.23	255.01	537.8	495.28	368	1142.8	828.53	828.53	828.53	828.53	828.53	828.53	828.53	1285.65	384.94	1285.65	217.16	828.53	828.53	217.16	1285.65
74178	2	350	74178	CT SCAN - GENERAL		1428.5
74178	3
74181	1	1		MRI OF ABDOMEN WITHOUT CONTRAST	OUT	1208.6	725.16	1027.31	317.38	513.59	472.98	650	966.88	700.99	700.99	700.99	700.99	700.99	700.99	700.99	1087.74	325.68	1087.74	152.32	700.99	700.99	152.32	1087.74
74181	2	614	74181	MRI - OTHER		1208.6
74181	3
74183	1	1		MRI OF ABDOMEN WITH AND WITHOUT CONTRAST	OUT	1785.7	1071.42	1517.85	704.76	791.63	729.04	650	1428.56	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1035.71	1607.13	481.19	1607.13	247.26	1035.71	1035.71	247.26	1607.13
74183	2	614	74183	MRI - OTHER		1785.7
74183	3
75574	1	1		CT ANGIOGRAM HEART CORONARY ARTERIES AND GRAFTS	OUT	1763.43	1058.06	1498.92	348.79	778.51	715.29	573.64	1410.74	1022.79	1022.79	1022.79	1022.79	1022.79	1022.79	1022.79	1587.09	475.19	1587.09	132.24	1022.79	1022.79	132.24	1587.09
75574	2	250		PHARMACY		156.73
75574	3	350	75574	CT SCAN - GENERAL		1428.5
75574	4	730	93005	EKG / ECG		178.2
75574	5
75635	1	1		CT ANGIOGRAPHY ABDOMINAL AORTA WITH CONTRAST	OUT	1050.3	630.18	892.76	241.52	581.49	535.51	368	840.24	609.17	609.17	609.17	609.17	609.17	609.17	609.17	945.27	283.02	945.27	152.66	609.17	609.17	152.66	945.27
75635	2	350	75635	CT SCAN - GENERAL		1050.3
75635	3
76536	1	1		ULTRASOUND SOFT TISSUE HEAD AND NECK W IMAGING	OUT	425.4	255.24	361.59	40.08	182.99	168.52	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	40.08	382.86
76536	2	402	76536	OTHER IMAGING - ULTRASOUND		425.4
76536	3
76604	1	1		ULTRASOUND CHEST REAL TIME WITH IMAGE DOCUMENT	OUT	425.4	255.24	361.59	36.83	119.37	109.93	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	29.06	382.86
76604	2	402	76604	OTHER IMAGING - ULTRASOUND		425.4
76604	3
76641	1	1		ULTRASOUND BREAST UNILATERAL COMPLETE	OUT	425.4	255.24	361.59	52.32	138.46	127.51	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	41.25	246.73	246.73	41.25	382.86
76641	2	402	76641	OTHER IMAGING - ULTRASOUND		425.4
76641	3
76641-50	1	1		ULTRASOUND BREAST BILATERAL COMPLETE	OUT	638	382.8	542.3	52.32	138.46	127.51	391.73	510.4	370.04	370.04	370.04	370.04	370.04	370.04	370.04	574.2	171.92	574.2	41.25	370.04	370.04	41.25	574.2
76641-50	2	402	76641	OTHER IMAGING - ULTRASOUND		638
76641-50	3
76642-50	1	1		ULTRASOUND BREAST BILATERAL LIMITED	OUT	528.3	316.98	449.06	40.06	106.02	97.63	324.38	422.64	306.41	306.41	306.41	306.41	306.41	306.41	306.41	475.47	142.36	475.47	41.25	306.41	306.41	40.06	475.47
76642-50	2	402	76642	OTHER IMAGING - ULTRASOUND		528.3
76642-50	3
76700	1	1		ULTRASOUND ABDOMEN COMPLETE	OUT	425.4	255.24	361.59	55.69	196.14	180.64	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	44.69	382.86
76700	2	402	76700	OTHER IMAGING - ULTRASOUND		425.4
76700	3
76705	1	1		ULTRASOUND ABDOMEN LIMITED	OUT	425.4	255.24	361.59	40.08	154.63	142.4	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	40.08	382.86
76705	2	402	76705	OTHER IMAGING - ULTRASOUND		425.4
76705	3
76706	1	1		ULTRASOUND ABDOMINAL AORTA REAL TIME (AAA STUDY)	OUT	425.4	255.24	361.59	48.97	129.58	119.33	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	50.73	246.73	246.73	48.97	382.86
76706	2	402	76706	OTHER IMAGING - ULTRASOUND		425.4
76706	3
76770	1	1		ULTRASOUND RETROPERITONEAL (KIDNEY/BLADDER/AORTA)	OUT	425.4	255.24	361.59	55.69	187.14	172.34	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	44.69	382.86
76770	2	402	76770	OTHER IMAGING - ULTRASOUND		425.4
76770	3
76775	1	1		ULTRASOUND RETROPERITONEAL LIMITED	OUT	425.4	255.24	361.59	40.08	70.95	65.34	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	40.08	382.86
76775	2	402	76775	OTHER IMAGING - ULTRASOUND		425.4
76775	3
76801	1	1		ULTRASOUND PREGNANT UTERUS TRANSABD SINGLE <14 WKS	OUT	425.4	255.24	361.59	29.75	150.48	138.58	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	29.75	382.86
76801	2	402	76801	OTHER IMAGING - ULTRASOUND		425.4
76801	3
76805	1	1		ULTRASOUND PREGNANT UTERUS > 14 WEEKS SINGLE	OUT	476.6	285.96	405.11	59.47	188.53	173.63	292.63	381.28	276.43	276.43	276.43	276.43	276.43	276.43	276.43	428.94	128.43	428.94	44.69	276.43	276.43	44.69	428.94
76805	2	402	76805	OTHER IMAGING - ULTRASOUND		476.6
76805	3
76815	1	1		ULTRASOUND PREGNANT UTERUS WITH IMAGE LIMITED	OUT	425.4	255.24	361.59	40.08	113.13	104.19	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	29.06	382.86
76815	2	402	76815	OTHER IMAGING - ULTRASOUND		425.4
76815	3
76816	1	1		ULTRASOUND PREGNANT UTERUS TRANSABD FOLLOW-UP	OUT	425.4	255.24	361.59	31.36	143.58	132.22	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	29.06	382.86
76816	2	402	76816	OTHER IMAGING - ULTRASOUND		425.4
76816	3
76817	1	1		ULTRASOUND PREGNANT UTERUS W IMAGE TRANSVAGINAL	OUT	425.4	255.24	361.59	41.51	124.21	114.38	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	29.06	382.86
76817	2	402	76817	OTHER IMAGING - ULTRASOUND		425.4
76817	3
76830	1	1		ULTRASOUND PELVIS THROUGH VAGINA (NON-OB)	OUT	425.4	255.24	361.59	43.3	178.84	164.7	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	43.3	382.86
76830	2	402	76830	OTHER IMAGING - ULTRASOUND		425.4
76830	3
76856	1	1		ULTRASOUND PELVIS NON-OB COMPLETE TRANSABDOMINAL	OUT	425.4	255.24	361.59	43.3	175.4	161.53	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	43.3	382.86
76856	2	402	76856	OTHER IMAGING - ULTRASOUND		425.4
76856	3
76857	1	1		ULTRASOUND PELVIS NON-OB LIMITED TRANSABDOMINAL	OUT	425.4	255.24	361.59	29.66	67.49	62.15	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	29.06	382.86
76857	2	402	76857	OTHER IMAGING - ULTRASOUND		425.4
76857	3
76870	1	1		ULTRASOUND SCROTUM AND CONTENTS	OUT	425.4	255.24	361.59	43.3	81.33	74.9	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	43.3	382.86
76870	2	402	76870	OTHER IMAGING - ULTRASOUND		425.4
76870	3
76881	1	1		ULTRASOUND COMPLETE JOINT (TISSUE TENDON MUSCLE)	OUT	425.4	255.24	361.59	66.15	169.16	155.79	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	44.69	246.73	246.73	44.69	382.86
76881	2	402	76881	OTHER IMAGING - ULTRASOUND		425.4
76881	3
76882	1	1		ULTRASOUND LIMITED JOINT (TISSUE TENDON MUSCLE)	OUT	425.4	255.24	361.59	7.72	21.16	19.48	261.2	340.32	246.73	246.73	246.73	246.73	246.73	246.73	246.73	382.86	114.63	382.86	29.06	246.73	246.73	7.72	382.86
76882	2	402	76882	OTHER IMAGING - ULTRASOUND		425.4
76882	3
77065	1	1		MAMMOGRAM OF ONE BREAST	OUT	756.3	453.78	642.86	69.43	233.15	214.71	464.37	605.04	438.65	438.65	438.65	438.65	438.65	438.65	438.65	680.67	203.8	680.67	54.85	438.65	438.65	54.85	680.67
77065	2	401	77065	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		556.6
77065	3	401	G0279	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		199.7
77065	4
77065/76642	1	1		MAMMOGRAM OF ONE BREAST WITH ULTRASOUND	OUT	1108.5	665.1	942.23	109.49	339.17	312.34	680.62	886.8	642.93	642.93	642.93	642.93	642.93	642.93	642.93	997.65	298.71	997.65	96.1	642.93	642.93	96.1	997.65
77065/76642	2	401	77065	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		556.6
77065/76642	3	401	G0279	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		199.7
77065/76642	4	402	76642	OTHER IMAGING - ULTRASOUND		352.2
77065/76642	5
77066	1	1		MAMMOGRAM OF BOTH BREASTS	OUT	901.5	540.9	766.28	88.85	284.53	262.03	553.53	721.2	522.87	522.87	522.87	522.87	522.87	522.87	522.87	811.35	242.93	811.35	66.84	522.87	522.87	66.84	811.35
77066	2	401	77066	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		701.8
77066	3	401	G0279	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		199.7
77066	4
77066/76642	1	1		MAMMOGRAM OF BOTH BREASTS WITH ULTRASOUND	OUT	1253.7	752.22	1065.65	128.91	390.55	359.66	769.78	1002.96	727.15	727.15	727.15	727.15	727.15	727.15	727.15	1128.33	337.83	1128.33	108.09	727.15	727.15	108.09	1128.33
77066/76642	2	401	77066	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		701.8
77066/76642	3	401	G0279	OTHER IMAGING - DIAGNOSTIC MAMMOGRAPHY		199.7
77066/76642	4	402	76642	OTHER IMAGING - ULTRASOUND		352.2
77066/76642	5
77067	1	1		MAMMOGRAM SCREENING BILATERAL	OUT	643	385.8	546.55	92.03	243.56	224.29	394.8	514.4	323.96	323.96	323.96	323.96	323.96	323.96	323.96	578.7	173.27	578.7	57.28	323.96	323.96	57.28	578.7
77067	2	403	77063	OTHER IMAGING - SCREENING MAMMOGRAPHY		188.7
77067	3	403	77067	OTHER IMAGING - SCREENING MAMMOGRAPHY		454.3
77067	4
77067/77080	1	1		MAMMOGRAM SCREENING BILATERAL W BONE DENSITY SCAN	OUT	962	577.2	817.7	163.1	318.66	293.45	590.67	769.6	508.98	508.98	508.98	508.98	508.98	508.98	508.98	865.8	259.23	865.8	90.52	508.98	508.98	90.52	865.8
77067/77080	2	320	77080	RADIOLOGY - GENERAL		319
77067/77080	3	403	77063	OTHER IMAGING - SCREENING MAMMOGRAPHY		188.7
77067/77080	4	403	77067	OTHER IMAGING - SCREENING MAMMOGRAPHY		454.3
77067/77080	5
77072	1	1		BONE AGE STUDIES	OUT	319	191.4	271.15	9.6	27.37	25.21	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	20.68	185.02	185.02	9.6	287.1
77072	2	320	77072	RADIOLOGY - GENERAL		319
77072	3
77080	1	1		BONE DENSITY SCAN AXIAL BONES (HIP/SPINE/PELVIS)	OUT	319	191.4	271.15	71.07	75.1	69.16	195.87	255.2	185.02	185.02	185.02	185.02	185.02	185.02	185.02	287.1	85.96	287.1	33.24	185.02	185.02	33.24	287.1
77080	2	320	77080	RADIOLOGY - GENERAL		319
77080	3
78014	1	1		NUCLEAR MEDICINE THYROID SCAN	OUT	1784.05	1070.43	1516.44	159.3	413.42	380.73	986.88	1427.24	1034.75	1034.75	1034.75	1034.75	1034.75	1034.75	1034.75	1605.65	480.74	1605.65	104.82	1034.75	1034.75	104.82	1605.65
78014	2	341	78014	NUCLEAR MEDICINE - DIAGNOSTIC		1607.3
78014	3	343	A9516	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		176.75
78014	4
78226	1	1		NUCLEAR MEDICINE HEPATOBILIARY IMAGING	OUT	1859.5	1115.7	1580.58	213.75	580.8	534.88	986.88	1487.6	1078.51	1078.51	1078.51	1078.51	1078.51	1078.51	1078.51	1673.55	501.08	1673.55	141.48	1078.51	1078.51	141.48	1673.55
78226	2	341	78226	NUCLEAR MEDICINE - DIAGNOSTIC		1607.3
78226	3	343	A9537	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		252.2
78226	4
78227	1	1		NUCLEAR MEDICINE HEPATOBILIARY IMAGING WITH DRUG	OUT	2405.3	1443.18	2044.51	296.83	796.98	733.97	1322	1924.24	1395.07	1395.07	1395.07	1395.07	1395.07	1395.07	1395.07	2164.77	648.15	2164.77	141.48	1395.07	1395.07	141.48	2164.77
78227	2	341	78227	NUCLEAR MEDICINE - DIAGNOSTIC		2153.1
78227	3	343	A9537	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		252.2
78227	4
78264	1	1		NUCLEAR MEDICINE GASTRIC EMPTYING IMAGING STUDY	OUT	2241.8	1345.08	1905.53	116.58	489.51	450.81	986.88	1793.44	1300.24	1300.24	1300.24	1300.24	1300.24	1300.24	1300.24	2017.62	604.09	2017.62	115.54	1300.24	1300.24	115.54	2017.62
78264	2	341	78264	NUCLEAR MEDICINE - DIAGNOSTIC		1607.3
78264	3	343	A9541	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		634.5
78264	4
78300	1	1		NUCLEAR MEDICINE LIMITED BONE SCAN	OUT	1675.75	1005.45	1424.39	70.58	295.15	271.81	986.88	1340.6	971.94	971.94	971.94	971.94	971.94	971.94	971.94	1508.18	451.56	1508.18	117.76	971.94	971.94	70.58	1508.18
78300	2	340	78300	NUCLEAR MEDICINE - GENERAL		1607.3
78300	3	343	A9503	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		68.45
78300	4
78306	1	1		NUCLEAR MEDICINE FULL-BODY BONE SCAN	OUT	1675.75	1005.45	1424.39	120.94	411.34	378.81	986.88	1340.6	971.94	971.94	971.94	971.94	971.94	971.94	971.94	1508.18	451.56	1508.18	117.76	971.94	971.94	117.76	1508.18
78306	2	340	78306	NUCLEAR MEDICINE - GENERAL		1607.3
78306	3	343	A9503	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		68.45
78306	4
78315	1	1		NUCLEAR MEDICINE THREE-PHASE BONE SCAN	OUT	1675.75	1005.45	1424.39	135.13	587.72	541.25	986.88	1340.6	971.94	971.94	971.94	971.94	971.94	971.94	971.94	1508.18	451.56	1508.18	117.76	971.94	971.94	117.76	1508.18
78315	2	340	78315	NUCLEAR MEDICINE - GENERAL		1607.3
78315	3	343	A9503	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		68.45
78315	4
78452/93017	1	1		MYOCARDIAL PERFUSION IMAGING (SPECT) W STRESS TEST	OUT	6921.23	4152.74	5883.05	268.27	1615.39	1493.85	3937.61	5536.98	4014.31	4014.31	4014.31	4014.31	4014.31	4014.31	4014.31	6229.11	1865.05	6229.11	385.43	4014.31	4014.31	268.27	6229.11
78452/93017	2	250		PHARMACY		256.93
78452/93017	3	340	78452	NUCLEAR MEDICINE - GENERAL		5221.9
78452/93017	4	343	A9500	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		508.2
78452/93017	5	482	93017	CARDIOLOGY - STRESS TEST		934.2
78452/93017	6
78452/93306	1	1		MYOCARDIAL PERFUSION IMAGING (SPECT) W ECHO (TTE)	OUT	9989.08	5993.45	8490.72	417.04	2789.21	2558.01	5821.27	7991.26	5793.67	5793.67	5793.67	5793.67	5793.67	5793.67	5793.67	8990.17	2691.74	8990.17	585.29	5793.67	5793.67	417.04	8990.17
78452/93306	2	250		PHARMACY		256.93
78452/93306	3	340	78452	NUCLEAR MEDICINE - GENERAL		5221.9
78452/93306	4	343	A9500	NUCLEAR MEDICINE - RADIOPHARM DIAGNOSTIC		508.2
78452/93306	5	482	93017	CARDIOLOGY - STRESS TEST		934.2
78452/93306	6	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
78452/93306	7	636	J2785	DRUGS - REQUIRING DETAIL CODING		874.65
78452/93306	8
80048	1	1		BASIC METABOLIC PANEL	OUT	50.8	30.48	43.18	8.76	20.23	18.63	31.19	40.64	29.46	29.46	29.46	29.46	29.46	29.46	29.46	45.72	13.69	45.72	5.23	29.46	29.46	5.23	45.72
80048	2	301	80048	LAB - CHEMISTRY		50.8
80048	3
80051	1	1		ELECTROLYTE PANEL	OUT	42.1	25.26	35.79	10.1	16.99	15.64	25.85	33.68	12.21	12.21	12.21	12.21	12.21	12.21	12.21	37.89	11.34	37.89	4.34	12.21	12.21	4.34	37.89
80051	2	301	80051	LAB - CHEMISTRY		42.1
80051	3
80053	1	1		COMPREHENSIVE METETABOLIC LAB PANEL	OUT	63.4	38.04	53.89	10.95	25.28	23.28	38.93	50.72	36.77	36.77	36.77	36.77	36.77	36.77	36.77	57.06	17.08	57.06	6.54	36.77	36.77	6.54	57.06
80053	2	301	80053	LAB - CHEMISTRY		63.4
80053	3
80055	1	1		OBSTETRIC LAB PANEL NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
80055	2
80061	1	1		LIPID (CHOLESTEROL/TRIGLYCERIDES) LAB PANEL	OUT	80.3	48.18	68.26	36.41	39.28	36.17	49.3	64.24	23.29	23.29	23.29	23.29	23.29	23.29	23.29	72.27	21.64	72.27	8.29	23.29	23.29	8.29	72.27
80061	2	301	80061	LAB - CHEMISTRY		80.3
80061	3
80069	1	1		RENAL (KIDNEY) FUNCTION LAB PANEL	OUT	52.1	31.26	44.29	8.76	20.23	18.63	31.99	41.68	15.11	15.11	15.11	15.11	15.11	15.11	15.11	46.89	14.04	46.89	5.37	15.11	15.11	5.37	46.89
80069	2	301	80069	LAB - CHEMISTRY		52.1
80069	3
80074	1	1		ACUTE HEPATITIS PANEL	OUT	285.8	171.48	242.93	58.39	135.11	124.42	175.48	228.64	82.88	82.88	82.88	82.88	82.88	82.88	82.88	257.22	77.01	257.22	29.46	82.88	82.88	29.46	257.22
80074	2	300	80074	LABORATORY		285.8
80074	3
80076	1	1		HEPATIC (LIVER) FUNCTION LAB PANEL	OUT	49	29.4	41.65	8.76	20.23	18.63	30.09	39.2	14.21	14.21	14.21	14.21	14.21	14.21	14.21	44.1	13.2	44.1	5.05	14.21	14.21	5.05	44.1
80076	2	301	80076	LAB - CHEMISTRY		49
80076	3
80178	1	1		DRUG SCREEN LITHIUM	OUT	39.7	23.82	33.75	9.85	19.39	17.86	24.38	31.76	11.51	11.51	11.51	11.51	11.51	11.51	11.51	35.73	10.7	35.73	4.09	11.51	11.51	4.09	35.73
80178	2	301	80178	LAB - CHEMISTRY		39.7
80178	3
80185	1	1		DRUG SCREEN PHENYTOIN TOTAL	OUT	79.5	47.7	67.58	24.94	38.89	35.82	48.81	63.6	23.06	23.06	23.06	23.06	23.06	23.06	23.06	71.55	21.42	71.55	8.2	23.06	23.06	8.2	71.55
80185	2	301	80185	LAB - CHEMISTRY		79.5
80185	3
80197	1	1		TACROLIMUS ASSAY	OUT	82.4	49.44	70.04	12.4	40.27	37.09	50.59	65.92	47.79	47.79	47.79	47.79	47.79	47.79	47.79	74.16	22.2	74.16	8.49	47.79	47.79	8.49	74.16
80197	2	301	80197	LAB - CHEMISTRY		82.4
80197	3
80202	1	1		ASSAY OF VANCOMYCIN (ANTIBIOTIC) LEVEL	OUT	81.2	48.72	69.02	23.72	39.75	36.61	49.86	64.96	47.1	47.1	47.1	47.1	47.1	47.1	47.1	73.08	21.88	73.08	8.38	47.1	47.1	8.38	73.08
80202	2	301	80202	LAB - CHEMISTRY		81.2
80202	3
81001	1	1		URINALYSIS WITH MICROSCOPY (AUTOMATED)	OUT	19	11.4	16.15	2.22	9.29	8.55	11.67	15.2	11.02	11.02	11.02	11.02	11.02	11.02	11.02	17.1	5.12	17.1	1.96	11.02	11.02	1.96	17.1
81001	2	307	81001	LAB - UROLOGY		19
81001	3
81003	1	1		URINALYSIS WITHOUT MICROSCOPY (AUTOMATED)	OUT	13.5	8.1	11.48	1.79	6.58	6.06	8.29	10.8	3.92	3.92	3.92	3.92	3.92	3.92	3.92	12.15	3.64	12.15	1.39	3.92	3.92	1.39	12.15
81003	2	307	81003	LAB - UROLOGY		13.5
81003	3
81025	1	1		URINE PREGNANCY TEST	OUT	51.7	31.02	43.95	6.72	18.55	17.09	31.74	41.36	14.99	14.99	14.99	14.99	14.99	14.99	14.99	46.53	13.93	46.53	3.92	14.99	14.99	3.92	46.53
81025	2	307	81025	LAB - UROLOGY		51.7
81025	3
82040	1	1		ALBUMIN SERUM (PLASMA / BLOOD)	OUT	29.7	17.82	25.25	9.23	14.51	13.37	18.24	23.76	8.61	8.61	8.61	8.61	8.61	8.61	8.61	26.73	8	26.73	3.06	8.61	8.61	3.06	26.73
82040	2	301	82040	LAB - CHEMISTRY		29.7
82040	3
82043	1	1		ALBUMIN URINE MICROALBUMIN QUANTITATIVE	OUT	34.7	20.82	29.5	34.7	6.88	6.34	21.31	27.76	10.06	10.06	10.06	10.06	10.06	10.06	10.06	31.23	9.35	31.23	3.58	10.06	10.06	3.58	34.7
82043	2	301	82043	LAB - CHEMISTRY		34.7
82043	3
82140	1	1		ASSAY OF AMMONIA	OUT	87.4	52.44	74.29	28.67	42.74	39.36	53.66	69.92	25.35	25.35	25.35	25.35	25.35	25.35	25.35	78.66	23.55	78.66	9.01	25.35	25.35	9.01	78.66
82140	2	301	82140	LAB - CHEMISTRY		87.4
82140	3
82150	1	1		ASSAY OF AMYLASE	OUT	38.9	23.34	33.07	12.71	19.01	17.5	23.88	31.12	22.56	22.56	22.56	22.56	22.56	22.56	22.56	35.01	10.48	35.01	4.01	22.56	22.56	4.01	35.01
82150	2	301	82150	LAB - CHEMISTRY		38.9
82150	3
82247	1	1		BILIRUBIN TOTAL	OUT	30.1	18.06	25.59	8.76	14.71	13.54	18.48	24.08	8.73	8.73	8.73	8.73	8.73	8.73	8.73	27.09	8.11	27.09	3.11	8.73	8.73	3.11	27.09
82247	2	301	82247	LAB - CHEMISTRY		30.1
82247	3
82248	1	1		BILIRUBIN DIRECT	OUT	30.1	18.06	25.59	8.76	14.71	13.54	18.48	24.08	8.73	8.73	8.73	8.73	8.73	8.73	8.73	27.09	8.11	27.09	3.11	8.73	8.73	3.11	27.09
82248	2	301	82248	LAB - CHEMISTRY		30.1
82248	3
82306	1	1		VITAMIN D ASSAY	OUT	177.6	106.56	150.96	56.64	86.86	79.99	109.05	142.08	103.01	103.01	103.01	103.01	103.01	103.01	103.01	159.84	47.86	159.84	18.32	103.01	103.01	18.32	159.84
82306	2	301	82306	LAB - CHEMISTRY		177.6
82306	3
82310	1	1		ASSAY OF CALCIUM	OUT	31	18.6	26.35	9.52	15.14	13.94	19.03	24.8	8.99	8.99	8.99	8.99	8.99	8.99	8.99	27.9	8.35	27.9	3.19	8.99	8.99	3.19	27.9
82310	2	301	82310	LAB - CHEMISTRY		31
82310	3
82465	1	1		SERUM CHOLESTEROL TOTAL	OUT	26.1	15.66	22.19	8.5	12.75	11.74	16.03	20.88	7.57	7.57	7.57	7.57	7.57	7.57	7.57	23.49	7.03	23.49	2.69	7.57	7.57	2.69	23.49
82465	2	301	82465	LAB - CHEMISTRY		26.1
82465	3
82533	1	1		CORTISOL TOTAL	OUT	97.8	58.68	83.13	31.65	47.82	44.04	60.05	78.24	56.72	56.72	56.72	56.72	56.72	56.72	56.72	88.02	26.35	88.02	10.08	56.72	56.72	10.08	88.02
82533	2	301	82533	LAB - CHEMISTRY		97.8
82533	3
82550	1	1		CREATINE KINASE (CK) CARDIAC ENZYME TOTAL	OUT	39.1	23.46	33.24	12.71	19.09	17.58	24.01	31.28	22.68	22.68	22.68	22.68	22.68	22.68	22.68	35.19	10.54	35.19	4.03	22.68	22.68	4.03	35.19
82550	2	301	82550	LAB - CHEMISTRY		39.1
82550	3
82565	1	1		BLOOD CREATININE LEVEL	OUT	30.7	18.42	26.1	10.14	15.03	13.84	18.85	24.56	8.9	8.9	8.9	8.9	8.9	8.9	8.9	27.63	8.27	27.63	3.17	8.9	8.9	3.17	27.63
82565	2	301	82565	LAB - CHEMISTRY		30.7
82565	3
82570	1	1		URINE CREATININE LEVEL	OUT	31.1	18.66	26.44	10.16	15.18	13.98	19.1	24.88	18.04	18.04	18.04	18.04	18.04	18.04	18.04	27.99	8.38	27.99	3.2	18.04	18.04	3.2	27.99
82570	2	301	82570	LAB - CHEMISTRY		31.1
82570	3
82607	1	1		ASSAY OF CYANOCOBALAMIN (VITAMIN B-12)	OUT	90.5	54.3	76.93	29.6	44.2	40.71	55.57	72.4	26.25	26.25	26.25	26.25	26.25	26.25	26.25	81.45	24.39	81.45	9.32	26.25	26.25	9.32	81.45
82607	2	301	82607	LAB - CHEMISTRY		90.5
82607	3
82670	1	1		ASSAY OF ESTRADIOL	OUT	167.6	100.56	142.46	54.5	81.96	75.48	102.91	134.08	97.21	97.21	97.21	97.21	97.21	97.21	97.21	150.84	45.16	150.84	17.28	97.21	97.21	17.28	150.84
82670	2	301	82670	LAB - CHEMISTRY		167.6
82670	3
82728	1	1		ASSAY OF FERRITIN	OUT	81.8	49.08	69.53	26.77	39.97	36.81	50.23	65.44	23.72	23.72	23.72	23.72	23.72	23.72	23.72	73.62	22.04	73.62	8.43	23.72	23.72	8.43	73.62
82728	2	301	82728	LAB - CHEMISTRY		81.8
82728	3
82746	1	1		ASSAY OF SERUM FOLIC ACID	OUT	88.2	52.92	74.97	28.45	43.13	39.72	54.15	70.56	25.58	25.58	25.58	25.58	25.58	25.58	25.58	79.38	23.77	79.38	9.09	25.58	25.58	9.09	79.38
82746	2	301	82746	LAB - CHEMISTRY		88.2
82746	3
82784	1	1		ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH	OUT	55.8	33.48	47.43	18.28	27.26	25.11	34.26	44.64	32.36	32.36	32.36	32.36	32.36	32.36	32.36	50.22	15.04	50.22	5.75	32.36	32.36	5.75	50.22
82784	2	301	82784	LAB - CHEMISTRY		55.8
82784	3
82785	1	1		ASSAY OF GAMMAGLOBULIN IGE	OUT	98.8	59.28	83.98	32.05	48.31	44.49	60.66	79.04	28.65	28.65	28.65	28.65	28.65	28.65	28.65	88.92	26.62	88.92	10.19	28.65	28.65	10.19	88.92
82785	2	301	82785	LAB - CHEMISTRY		98.8
82785	3
82947	1	1		BLOOD GLUCOSE TESTING (EXCEPT REAGENT STRIP)	OUT	23.6	14.16	20.06	7.73	11.52	10.61	14.49	18.88	6.84	6.84	6.84	6.84	6.84	6.84	6.84	21.24	6.36	21.24	2.43	6.84	6.84	2.43	21.24
82947	2	301	82947	LAB - CHEMISTRY		23.6
82947	3
82951	1	1		GLUCOSE TOLERANCE TEST (GTT)	OUT	77.2	46.32	65.62	14.45	25.65	23.62	47.4	61.76	22.39	22.39	22.39	22.39	22.39	22.39	22.39	69.48	20.8	69.48	7.96	22.39	22.39	7.96	69.48
82951	2	301	82951	LAB - CHEMISTRY		77.2
82951	3
83001	1	1		FOLLICLE STIMULATING HORMONE (FSH)	OUT	111.5	66.9	94.78	36.52	54.5	50.19	68.46	89.2	32.34	32.34	32.34	32.34	32.34	32.34	32.34	100.35	30.05	100.35	11.49	32.34	32.34	11.49	100.35
83001	2	301	83001	LAB - CHEMISTRY		111.5
83001	3
83002	1	1		LUTEINIZING HORMONE (LH)	OUT	111.5	66.9	94.78	35.49	54.31	50.01	68.46	89.2	32.34	32.34	32.34	32.34	32.34	32.34	32.34	100.35	30.05	100.35	11.46	32.34	32.34	11.46	100.35
83002	2	301	83002	LAB - CHEMISTRY		111.5
83002	3
83036	1	1		HEMOGLOBIN GLYCOSYLATED (A1C)	OUT	58.3	34.98	49.56	18.59	28.47	26.22	35.8	46.64	33.81	33.81	33.81	33.81	33.81	33.81	33.81	52.47	15.71	52.47	6	33.81	33.81	6	52.47
83036	2	301	83036	LAB - CHEMISTRY		58.3
83036	3
83540	1	1		ASSAY OF IRON	OUT	38.8	23.28	32.98	12.71	18.98	17.48	23.82	31.04	22.5	22.5	22.5	22.5	22.5	22.5	22.5	34.92	10.46	34.92	4.01	22.5	22.5	4.01	34.92
83540	2	301	83540	LAB - CHEMISTRY		38.8
83540	3
83550	1	1		IRON BINDING CAPACITY	OUT	52.4	31.44	44.54	18.11	25.65	23.62	32.17	41.92	15.2	15.2	15.2	15.2	15.2	15.2	15.2	47.16	14.12	47.16	5.41	15.2	15.2	5.41	47.16
83550	2	301	83550	LAB - CHEMISTRY		52.4
83550	3
83605	1	1		ASSAY OF LACTATE	OUT	69.4	41.64	58.99	20.77	31.33	28.85	42.61	55.52	40.25	40.25	40.25	40.25	40.25	40.25	40.25	62.46	18.7	62.46	6.61	40.25	40.25	6.61	62.46
83605	2	301	83605	LAB - CHEMISTRY		69.4
83605	3
83615	1	1		LACTATE DEHYDROGENASE (LDH) LEVEL	OUT	36.2	21.72	30.77	11.54	17.69	16.3	22.23	28.96	21	21	21	21	21	21	21	32.58	9.75	32.58	3.74	21	21	3.74	32.58
83615	2	301	83615	LAB - CHEMISTRY		36.2
83615	3
83690	1	1		ASSAY OF LIPASE	OUT	41.3	24.78	35.11	13.53	20.21	18.61	25.36	33.04	23.95	23.95	23.95	23.95	23.95	23.95	23.95	37.17	11.13	37.17	4.26	23.95	23.95	4.26	37.17
83690	2	301	83690	LAB - CHEMISTRY		41.3
83690	3
83735	1	1		ASSAY OF MAGNESIUM	OUT	40.2	24.12	34.17	13.08	19.65	18.1	24.68	32.16	23.32	23.32	23.32	23.32	23.32	23.32	23.32	36.18	10.83	36.18	4.14	23.32	23.32	4.14	36.18
83735	2	301	83735	LAB - CHEMISTRY		40.2
83735	3
83880	1	1		NATRIURETIC PEPTIDE TESTING	OUT	235.6	141.36	200.26	36.85	99.57	91.69	144.66	188.48	68.32	68.32	68.32	68.32	68.32	68.32	68.32	212.04	63.49	212.04	21	68.32	68.32	21	212.04
83880	2	301	83880	LAB - CHEMISTRY		235.6
83880	3
83970	1	1		ASSAY OF PARATHORMONE	OUT	247.7	148.62	210.55	68.37	121.07	111.49	152.09	198.16	71.83	71.83	71.83	71.83	71.83	71.83	71.83	222.93	66.75	222.93	25.53	71.83	71.83	25.53	222.93
83970	2	301	83970	LAB - CHEMISTRY		247.7
83970	3
84100	1	1		ASSAY OF PHOSPHORUS	OUT	28.4	17.04	24.14	7.22	12.81	11.8	17.44	22.72	16.47	16.47	16.47	16.47	16.47	16.47	16.47	25.56	7.65	25.56	2.93	16.47	16.47	2.93	25.56
84100	2	301	84100	LAB - CHEMISTRY		28.4
84100	3
84132	1	1		ASSAY OF SERUM POTASSIUM	OUT	28.4	17.04	24.14	8.93	13.48	12.41	17.44	22.72	16.47	16.47	16.47	16.47	16.47	16.47	16.47	25.56	7.65	25.56	2.84	16.47	16.47	2.84	25.56
84132	2	301	84132	LAB - CHEMISTRY		28.4
84132	3
84134	1	1		PREALBUMIN LC	OUT	87.5	52.5	74.38	13.66	36.85	33.94	53.73	70	25.38	25.38	25.38	25.38	25.38	25.38	25.38	78.75	23.58	78.75	9.02	25.38	25.38	9.02	78.75
84134	2	301	84134	LAB - CHEMISTRY		87.5
84134	3
84144	1	1		ASSAY OF PROGESTERONE	OUT	125.2	75.12	106.42	34.59	61.19	56.35	76.87	100.16	36.31	36.31	36.31	36.31	36.31	36.31	36.31	112.68	33.74	112.68	12.91	36.31	36.31	12.91	112.68
84144	2	301	84144	LAB - CHEMISTRY		125.2
84144	3
84153	1	1		PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL	OUT	110.3	66.18	93.76	13.41	53.94	49.68	67.72	88.24	63.97	63.97	63.97	63.97	63.97	63.97	63.97	99.27	29.72	99.27	11.38	63.97	63.97	11.38	99.27
84153	2	301	84153	LAB - CHEMISTRY		110.3
84153	3
84154	1	1		PROSTATE SPECIFIC ANTIGEN (PSA) FREE	OUT	110.3	66.18	93.76	32.07	53.94	49.68	67.72	88.24	31.99	31.99	31.99	31.99	31.99	31.99	31.99	99.27	29.72	99.27	11.38	31.99	31.99	11.38	99.27
84154	2	301	84154	LAB - CHEMISTRY		110.3
84154	3
84156	1	1		PROTEIN ELETROPHORESIS 24 HOUR URINE	OUT	22	13.2	18.7	4.16	10.75	9.9	13.51	17.6	12.76	12.76	12.76	12.76	12.76	12.76	12.76	19.8	5.93	19.8	2.27	12.76	12.76	2.27	19.8
84156	2	301	84156	LAB - CHEMISTRY		22
84156	3
84165	1	1		PROTEIN ELETROPHORESIS SERUM REFLEX IFE PANEL	OUT	98.9	59.34	84.07	21.17	31.5	29.01	60.72	79.12	57.36	57.36	57.36	57.36	57.36	57.36	57.36	89.01	26.65	89.01	6.64	57.36	57.36	6.64	89.01
84165	2	301	84165	LAB - CHEMISTRY		98.9
84165	3
84244	1	1		ASSAY OF RENIN	OUT	131.9	79.14	112.12	43.13	64.52	59.42	80.99	105.52	38.25	38.25	38.25	38.25	38.25	38.25	38.25	118.71	35.54	118.71	13.61	38.25	38.25	13.61	118.71
84244	2	301	84244	LAB - CHEMISTRY		131.9
84244	3
84403	1	1		ASSAY OF TOTAL TESTOSTERONE	OUT	154.9	92.94	131.67	50.57	75.72	69.74	95.11	123.92	44.92	44.92	44.92	44.92	44.92	44.92	44.92	139.41	41.74	139.41	15.97	44.92	44.92	15.97	139.41
84403	2	301	84403	LAB - CHEMISTRY		154.9
84403	3
84425	1	1		ASSAY OF VITAMIN B 1 (THIAMINE)	OUT	127.4	76.44	108.29	41.49	62.26	57.34	78.22	101.92	36.95	36.95	36.95	36.95	36.95	36.95	36.95	114.66	34.33	114.66	13.14	36.95	36.95	13.14	114.66
84425	2	301	84425	LAB - CHEMISTRY		127.4
84425	3
84439	1	1		ASSAY OF FREE THYROXINE	OUT	54.1	32.46	45.99	14.81	26.45	24.35	33.22	43.28	15.69	15.69	15.69	15.69	15.69	15.69	15.69	48.69	14.58	48.69	5.58	15.69	15.69	5.58	48.69
84439	2	301	84439	LAB - CHEMISTRY		54.1
84439	3
84443	1	1		THYROID STIMULATING HORMONE (TSH)	OUT	100.8	60.48	85.68	32.99	49.3	45.4	61.89	80.64	29.23	29.23	29.23	29.23	29.23	29.23	29.23	90.72	27.16	90.72	10.4	29.23	29.23	10.4	90.72
84443	2	301	84443	LAB - CHEMISTRY		100.8
84443	3
84450/84460	1	1		ASPARTATE AST SGOT AND ALANINE ALT SGPT AMINOTRNSF	OUT	62.9	37.74	53.47	20.32	30.7	28.28	38.62	50.32	18.24	18.24	18.24	18.24	18.24	18.24	18.24	56.61	16.95	56.61	6.47	18.24	18.24	6.47	56.61
84450/84460	2	301	84450	LAB - CHEMISTRY		31.1
84450/84460	3	301	84460	LAB - CHEMISTRY		31.8
84450/84460	4
84478	1	1		ASSAY OF TRIGLYCERIDES	OUT	34.4	20.64	29.24	11.88	16.86	15.52	21.12	27.52	9.98	9.98	9.98	9.98	9.98	9.98	9.98	30.96	9.27	30.96	3.56	9.98	9.98	3.56	30.96
84478	2	301	84478	LAB - CHEMISTRY		34.4
84478	3
84480	1	1		ASSAY OF TRIIODOTHYRONINE HORMONE T3 TOTAL	OUT	85.1	51.06	72.34	27.02	41.58	38.29	52.25	68.08	24.68	24.68	24.68	24.68	24.68	24.68	24.68	76.59	22.93	76.59	8.77	24.68	24.68	8.77	76.59
84480	2	301	84480	LAB - CHEMISTRY		85.1
84480	3
84481	1	1		ASSAY OF TRIIODOTHYRONINE HORMONE T3 FREE	OUT	101.6	60.96	86.36	33.27	49.69	45.76	62.38	81.28	29.46	29.46	29.46	29.46	29.46	29.46	29.46	91.44	27.38	91.44	10.48	29.46	29.46	10.48	91.44
84481	2	301	84481	LAB - CHEMISTRY		101.6
84481	3
84484	1	1		ASSAY OF TROPONIN QUANTITATIVE	OUT	74.8	44.88	63.58	43.45	28.85	26.57	45.93	59.84	43.38	43.38	43.38	43.38	43.38	43.38	43.38	67.32	20.16	67.32	6.09	43.38	43.38	6.09	67.32
84484	2	301	84484	LAB - CHEMISTRY		74.8
84484	3
84520	1	1		ASSAY OF UREA NITROGEN QUANTITATIVE	OUT	23.7	14.22	20.15	7.76	11.59	10.67	14.55	18.96	6.87	6.87	6.87	6.87	6.87	6.87	6.87	21.33	6.39	21.33	2.44	6.87	6.87	2.44	21.33
84520	2	301	84520	LAB - CHEMISTRY		23.7
84520	3
84550	1	1		ASSAY OF URIC ACID	OUT	27.1	16.26	23.04	8.5	13.24	12.2	16.64	21.68	7.86	7.86	7.86	7.86	7.86	7.86	7.86	24.39	7.3	24.39	2.79	7.86	7.86	2.79	24.39
84550	2	301	84550	LAB - CHEMISTRY		27.1
84550	3
85014/85018	1	1		HEMATOCRIT AND HEMOGLOBIN	OUT	28.72	17.23	24.41	9.26	13.88	12.8	17.63	22.98	8.33	8.33	8.33	8.33	8.33	8.33	8.33	25.85	7.74	25.85	2.94	8.33	8.33	2.94	25.85
85014/85018	2	305	85014	LAB - HEMATOLOGY		14.52
85014/85018	3	305	85018	LAB - HEMATOLOGY		14.2
85014/85018	4
85025	1	1		COMPLETE BLOOD COUNT (W WHITE BLOOD CELLS) AUTOMAT	OUT	46.6	27.96	39.61	15.14	22.81	21.01	28.61	37.28	27.03	27.03	27.03	27.03	27.03	27.03	27.03	41.94	12.56	41.94	4.81	27.03	27.03	4.81	41.94
85025	2	305	85025	LAB - HEMATOLOGY		46.6
85025	3
85027	1	1		COMPLETE BLOOD COUNT AUTOMATED	OUT	38.8	23.28	32.98	12.71	18.98	17.48	23.82	31.04	11.25	11.25	11.25	11.25	11.25	11.25	11.25	34.92	10.46	34.92	4	11.25	11.25	4	34.92
85027	2	305	85027	LAB - HEMATOLOGY		38.8
85027	3
85045	1	1		BLOOD COUNT RETICULOCYTE AUTOMATED	OUT	23.9	14.34	20.32	7.57	11.72	10.79	14.67	19.12	6.93	6.93	6.93	6.93	6.93	6.93	6.93	21.51	6.44	21.51	2.48	6.93	6.93	2.48	21.51
85045	2	305	85045	LAB - HEMATOLOGY		23.9
85045	3
85379	1	1		FIBRIN DEGRADATION PRODUCTS D-DIMER QUANTITATIVE	OUT	61.1	36.66	51.94	23.16	29.86	27.5	37.52	48.88	35.44	35.44	35.44	35.44	35.44	35.44	35.44	54.99	16.46	54.99	6.3	35.44	35.44	6.3	54.99
85379	2	305	85379	LAB - HEMATOLOGY		61.1
85379	3
85610	1	1		PROTHROMBIN (BLOOD CLOTTING) TIME	OUT	25.7	15.42	21.85	7.73	11.55	10.63	15.78	20.56	14.91	14.91	14.91	14.91	14.91	14.91	14.91	23.13	6.93	23.13	2.43	14.91	14.91	2.43	23.13
85610	2	305	85610	LAB - HEMATOLOGY		25.7
85610	3
85651	1	1		ERYTHROCYTE SEDIMENTATION RATE (ESR)	OUT	25.6	15.36	21.76	6.95	10.41	9.58	15.72	20.48	7.42	7.42	7.42	7.42	7.42	7.42	7.42	23.04	6.9	23.04	2.2	7.42	7.42	2.2	23.04
85651	2	300	85651	LABORATORY		25.6
85651	3
85730	1	1		THROMBOPLASTIN TIME PRTL (COAGULATION ASSESSMENT)	OUT	36.1	21.66	30.69	11.78	17.61	16.22	22.17	28.88	10.47	10.47	10.47	10.47	10.47	10.47	10.47	32.49	9.73	32.49	3.71	10.47	10.47	3.71	32.49
85730	2	305	85730	LAB - HEMATOLOGY		36.1
85730	3
86003	1	1		BLOOD SERUM ALLERGEN-SPECIFIC IGE (EACH)	OUT	125.2	75.12	106.42	86.28	61.23	56.39	76.87	100.16	72.62	72.62	72.62	72.62	72.62	72.62	72.62	112.68	33.74	112.68	12.92	72.62	72.62	12.92	112.68
86003	2	300	86003	LABORATORY		125.2
86003	3
86038	1	1		ANTINUCLEAR ANTIBODY (ANA) SCREEN	OUT	72.5	43.5	61.63	23.68	35.45	32.65	44.52	58	21.03	21.03	21.03	21.03	21.03	21.03	21.03	65.25	19.54	65.25	7.48	21.03	21.03	7.48	65.25
86038	2	302	86038	LAB - IMMUNOLOGY		72.5
86038	3
86140	1	1		C-REACTIVE PROTEIN	OUT	31.1	18.66	26.44	8.61	15.18	13.98	19.1	24.88	18.04	18.04	18.04	18.04	18.04	18.04	18.04	27.99	8.38	27.99	3.2	18.04	18.04	3.2	27.99
86140	2	302	86140	LAB - IMMUNOLOGY		31.1
86140	3
86160	1	1		COMPLIMENT ANTIGEN TWO COMPONENTS	OUT	144	86.4	122.4	33.82	70.43	64.86	88.42	115.2	83.52	83.52	83.52	83.52	83.52	83.52	83.52	129.6	38.8	129.6	14.86	83.52	83.52	14.86	129.6
86160	2	302	86160	LAB - IMMUNOLOGY		144
86160	3
86200	1	1		CYCLIC CITRULLINATED PEPTIDE (CCP) ANTIBODY	OUT	77.7	46.62	66.05	14.7	37.97	34.97	47.71	62.16	22.53	22.53	22.53	22.53	22.53	22.53	22.53	69.93	20.94	69.93	8.01	22.53	22.53	8.01	69.93
86200	2	300	86200	LABORATORY		77.7
86200	3
86225	1	1		DNA ANTIBODY NATIVE OR DOUBLE STRANDED	OUT	82.4	49.44	70.04	27.02	40.29	37.11	50.59	65.92	23.9	23.9	23.9	23.9	23.9	23.9	23.9	74.16	22.2	74.16	8.5	23.9	23.9	8.5	74.16
86225	2	302	86225	LAB - IMMUNOLOGY		82.4
86225	3
86235	1	1		EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD	OUT	322.8	193.68	274.38	103.71	157.77	145.29	198.2	258.24	187.22	187.22	187.22	187.22	187.22	187.22	187.22	290.52	86.98	290.52	33.27	187.22	187.22	33.27	290.52
86235	2	302	86235	LAB - IMMUNOLOGY		322.8
86235	3
86304	1	1		IMMUNOASSAY FOR TUMOR ANTIGEN QUANTITATIVE CA 125	OUT	124.9	74.94	106.17	23.37	61.04	56.21	76.69	99.92	36.22	36.22	36.22	36.22	36.22	36.22	36.22	112.41	33.66	112.41	12.87	36.22	36.22	12.87	112.41
86304	2	302	86304	LAB - IMMUNOLOGY		124.9
86304	3
86308	1	1		HETEROPHILE ANTIBODIES SCREENING	OUT	31.1	18.66	26.44	7.06	15.18	13.98	19.1	24.88	9.02	9.02	9.02	9.02	9.02	9.02	9.02	27.99	8.38	27.99	3.2	9.02	9.02	3.2	27.99
86308	2	302	86308	LAB - IMMUNOLOGY		31.1
86308	3
86431	1	1		RHEUMATOID FACTOR QUANTITATIVE	OUT	34	20.4	28.9	9.33	16.64	15.33	20.88	27.2	19.72	19.72	19.72	19.72	19.72	19.72	19.72	30.6	9.16	30.6	3.51	19.72	19.72	3.51	30.6
86431	2	302	86431	LAB - IMMUNOLOGY		34
86431	3
86592	1	1		SYPHILIS TEST QUALITATIVE (EG VDRL RPR ART)	OUT	25.6	15.36	21.76	6.78	12.06	11.11	15.72	20.48	7.42	7.42	7.42	7.42	7.42	7.42	7.42	23.04	6.9	23.04	2.64	7.42	7.42	2.64	23.04
86592	2	302	86592	LAB - IMMUNOLOGY		25.6
86592	3
86695/86696	1	1		HERPES SIMPLEX TYPE 1 AND TYPE 2	OUT	195.2	117.12	165.92	37.8	95.46	87.91	119.85	156.16	56.61	56.61	56.61	56.61	56.61	56.61	56.61	175.68	52.6	175.68	20.13	56.61	56.61	20.13	175.68
86695/86696	2	302	86695	LAB - IMMUNOLOGY		79.1
86695/86696	3	302	86696	LAB - IMMUNOLOGY		116.1
86695/86696	4
86704	1	1		HEPATITIS B CORE ANTIBODY (HBCAB) IGG AND IGM	OUT	72.3	43.38	61.46	21.03	35.35	32.55	44.39	57.84	20.97	20.97	20.97	20.97	20.97	20.97	20.97	65.07	19.48	65.07	7.46	20.97	20.97	7.46	65.07
86704	2	302	86704	LAB - IMMUNOLOGY		72.3
86704	3
86705	1	1		HEPATITIS B CORE IGM ANTIBODY	OUT	70.6	42.36	60.01	20.53	34.55	31.82	43.35	56.48	20.47	20.47	20.47	20.47	20.47	20.47	20.47	63.54	19.02	63.54	7.28	20.47	20.47	7.28	63.54
86705	2	302	86705	LAB - IMMUNOLOGY		70.6
86705	3
86706	1	1		HEPATITIS B SURFACE ANTIBODY	OUT	64.4	38.64	54.74	18.72	31.5	29.01	39.54	51.52	37.35	37.35	37.35	37.35	37.35	37.35	37.35	57.96	17.35	57.96	6.64	37.35	37.35	6.64	57.96
86706	2	302	86706	LAB - IMMUNOLOGY		64.4
86706	3
86738	1	1		ANTIBODY MYCOPLASMA	OUT	79.4	47.64	67.49	13.47	38.85	35.78	48.75	63.52	23.03	23.03	23.03	23.03	23.03	23.03	23.03	71.46	21.4	71.46	8.19	23.03	23.03	8.19	71.46
86738	2	302	86738	LAB - IMMUNOLOGY		79.4
86738	3
86762	1	1		RUBELLA ANTIBODY	OUT	86.3	51.78	73.36	9.33	42.23	38.89	52.99	69.04	25.03	25.03	25.03	25.03	25.03	25.03	25.03	77.67	23.26	77.67	8.91	25.03	25.03	8.91	77.67
86762	2	302	86762	LAB - IMMUNOLOGY		86.3
86762	3
86780	1	1		SYPHILIS ANTIBODY (TREPONEMA PALLIDUM)	OUT	79.4	47.64	67.49	15.41	38.83	35.76	48.75	63.52	23.03	23.03	23.03	23.03	23.03	23.03	23.03	71.46	21.4	71.46	8.19	23.03	23.03	8.19	71.46
86780	2	302	86780	LAB - IMMUNOLOGY		79.4
86780	3
86787	1	1		VARICELLA-ZOSTER ANTIBODY	OUT	77.3	46.38	65.71	29.27	37.8	34.81	47.46	61.84	44.83	44.83	44.83	44.83	44.83	44.83	44.83	69.57	20.83	69.57	7.97	44.83	44.83	7.97	69.57
86787	2	302	86787	LAB - IMMUNOLOGY		77.3
86787	3
86803	1	1		HEPATITIS C ANTIBODY	OUT	85.6	51.36	72.76	24.89	41.86	38.55	52.56	68.48	24.82	24.82	24.82	24.82	24.82	24.82	24.82	77.04	23.07	77.04	8.83	24.82	24.82	8.83	77.04
86803	2	302	86803	LAB - IMMUNOLOGY		85.6
86803	3
86900	1	1		BLOOD TYPING ABO	OUT	773.4	464.04	657.39	7.57	8.75	8.06	474.87	618.72	448.57	448.57	448.57	448.57	448.57	448.57	448.57	696.06	208.41	696.06	4.35	448.57	448.57	4.35	696.06
86900	2	302	86900	LAB - IMMUNOLOGY		773.4
86900	3
86901	1	1		BLOOD TYPING RH FACTOR	OUT	235.5	141.3	200.18	7.57	8.75	8.06	144.6	188.4	136.59	136.59	136.59	136.59	136.59	136.59	136.59	211.95	63.46	211.95	4.35	136.59	136.59	4.35	211.95
86901	2	302	86901	LAB - IMMUNOLOGY		235.5
86901	3
87070	1	1		BACTERIAL CULTURE (EXCEPT BLOOD URINE STOOL)	OUT	51.7	31.02	43.95	16.91	25.26	23.27	31.74	41.36	14.99	14.99	14.99	14.99	14.99	14.99	14.99	46.53	13.93	46.53	5.33	14.99	14.99	5.33	46.53
87070	2	306	87070	LAB - BACTERIOLOGY & MICROBIOLOGY		51.7
87070	3
87077	1	1		BACTERIAL CULTURE AEROBIC IDENTIFICATION W STREP	OUT	48.5	29.1	41.23	9.07	23.71	21.84	29.78	38.8	28.13	28.13	28.13	28.13	28.13	28.13	28.13	43.65	13.07	43.65	5	28.13	28.13	5	43.65
87077	2	306	87077	LAB - BACTERIOLOGY & MICROBIOLOGY		48.5
87077	3
87389	1	1		INFECTIOUS AGENT DETECTION HIV-1/2	OUT	144.5	86.7	122.83	27.72	70.65	65.06	88.72	115.6	41.91	41.91	41.91	41.91	41.91	41.91	41.91	130.05	38.94	130.05	14.9	41.91	41.91	14.9	130.05
87389	2	302	87389	LAB - IMMUNOLOGY		144.5
87389	3
87426	1	1		COVID-19 ANTIGEN TESTING	OUT	212	127.2	180.2	0	75.96	69.95	130.17	169.6	61.48	61.48	61.48	61.48	61.48	61.48	61.48	190.8	57.13	190.8	20.41	61.48	61.48	20.41	190.8
87426	2	301	87426	LAB - CHEMISTRY		212
87426	3
87522	1	1		HEPATITIS C DETECTION BY RNA QUANTIFICATION	OUT	257	154.2	218.45	75.7	125.65	115.71	157.8	205.6	74.53	74.53	74.53	74.53	74.53	74.53	74.53	231.3	69.25	231.3	26.5	74.53	74.53	26.5	231.3
87522	2	306	87522	LAB - BACTERIOLOGY & MICROBIOLOGY		257
87522	3
87591	1	1		INFECTIOUS AGENT DETECTION GONORRHEA	OUT	210.5	126.3	178.93	61.19	102.92	94.78	129.25	168.4	122.09	122.09	122.09	122.09	122.09	122.09	122.09	189.45	56.72	189.45	21.71	122.09	122.09	21.71	189.45
87591	2	306	87591	LAB - BACTERIOLOGY & MICROBIOLOGY		210.5
87591	3
87635	1	1		COVID-19 DETECTION BY AMPLIFIED PROBE TECHNIQUE	OUT	307.9	184.74	261.72	0	110.32	101.59	51.31	246.32	89.29	89.29	89.29	89.29	89.29	89.29	89.29	277.11	82.97	277.11	51.31	89.29	89.29	51.31	277.11
87635	2	306	87635	LAB - BACTERIOLOGY & MICROBIOLOGY		307.9
87635	3
87804	1	1		RAPID INFLUENZA TEST (ONE +/-)	OUT	99.3	59.58	84.41	12.87	33.58	30.93	60.97	79.44	28.8	28.8	28.8	28.8	28.8	28.8	28.8	89.37	26.76	89.37	7.42	28.8	28.8	7.42	89.37
87804	2	306	87804	LAB - BACTERIOLOGY & MICROBIOLOGY		99.3
87804	3
90832	1	1		PSYCHOTHERAPY 30 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90832	2
90834	1	1		PSYCHOTHERAPY 45 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90834	2
90837	1	1		PSYCHOTHERAPY 60 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90837	2
90846	1	1		FAMILY PSYCHOTHERAPY WITHOUT PATIENT NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90846	2
90847	1	1		FAMILY PSYCHOTHERAPY WITH PATIENT NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90847	2
90853	1	1		GROUP PSYCHOTHERAPY NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
90853	2
92507	1	1		SPEECH TREATMENT INDIVIDUAL	OUT	213.8	128.28	181.73	28.05	121.87	111.18	80	171.04	124	124	124	124	124	124	124	192.42	57.61	192.42	40	124	124	28.05	192.42
92507	2	440	92507	SPEECH - LANGUAGE PATHOLOGY		213.8
92507	3
92522	1	1		EVALUATE SPEECH SOUND PRODUCTION ARTICULATION	OUT	309.5	185.7	263.08	77.02	176.42	160.94	80	247.6	179.51	179.51	179.51	179.51	179.51	179.51	179.51	278.55	83.4	278.55	40	179.51	179.51	40	278.55
92522	2	444	92522	EVALUATION OR RE-EVALUATION		309.5
92522	3
92523	1	1		EVALUATE SPEECH SOUND WITH LANGUAGE COMPREHENSION	OUT	636.2	381.72	540.77	159.52	362.63	330.82	80	508.96	369	369	369	369	369	369	369	572.58	171.44	572.58	40	369	369	40	572.58
92523	2	444	92523	EVALUATION OR RE-EVALUATION		636.2
92523	3
92610	1	1		EVALUATE ORAL AND PHARYNGEAL SWALLOWING	OUT	236.1	141.66	200.69	32.48	134.58	122.77	80	188.88	136.94	136.94	136.94	136.94	136.94	136.94	136.94	212.49	63.62	212.49	70.16	136.94	136.94	32.48	212.49
92610	2	440	92610	SPEECH - LANGUAGE PATHOLOGY		236.1
92610	3
92611	1	1		FLUROSCOPIC EVALUATION OF SWALLOWING FUNCTION	OUT	785	471	667.25	72.19	271.37	248.68	407.94	628	455.3	455.3	455.3	455.3	455.3	455.3	455.3	706.5	211.53	706.5	116.57	455.3	455.3	72.19	706.5
92611	2	320	74230	RADIOLOGY - GENERAL		534.1
92611	3	440	92611	SPEECH - LANGUAGE PATHOLOGY		250.9
92611	4
93000	1	1		ELECTROCARDIOGRAM INTERPRET/REPORT NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
93000	2
93005	1	1		ELECTROCARDIOGRAM 12 LEADS TRACING ONLY	OUT	178.2	106.92	151.47	13.71	101.57	92.66	109.41	142.56	103.36	103.36	103.36	103.36	103.36	103.36	103.36	160.38	48.02	160.38	12	103.36	103.36	12	160.38
93005	2	730	93005	EKG / ECG		178.2
93005	3
93017	1	1		CARDIAC STRESS TEST (TREADMILL/BICYCLE) TRACING	OUT	934.2	560.52	794.07	51.25	532.49	485.78	573.6	747.36	541.84	541.84	541.84	541.84	541.84	541.84	541.84	840.78	251.74	840.78	79.57	541.84	541.84	51.25	840.78
93017	2	482	93017	CARDIOLOGY - STRESS TEST		934.2
93017	3
93225	1	1		HOLTER MONITOR ECG RECORDING UP TO 48 HRS	OUT	386.7	232.02	328.7	37.83	220.42	201.08	237.43	309.36	224.29	224.29	224.29	224.29	224.29	224.29	224.29	348.03	104.2	348.03	29.93	224.29	224.29	29.93	348.03
93225	2	731	93225	EKG / ECG - HOLTER MONITOR		386.7
93225	3
93225/93226	1	1		HOLTER MONITOR ECG RECORDING UP TO 48 HRS W REPORT	OUT	564.9	338.94	480.17	104.44	321.99	293.74	346.84	451.92	327.64	327.64	327.64	327.64	327.64	327.64	327.64	508.41	152.22	508.41	59.86	327.64	327.64	59.86	508.41
93225/93226	2	731	93225	EKG / ECG - HOLTER MONITOR		386.7
93225/93226	3	731	93226	EKG / ECG - HOLTER MONITOR		178.2
93225/93226	4
93270	1	1		CARDIOLOGY EVENT MONITOR RECORDING SING/MULT	OUT	111.9	67.14	95.12	37.19	63.78	58.19	68.71	89.52	64.9	64.9	64.9	64.9	64.9	64.9	64.9	100.71	30.15	100.71	29.93	64.9	64.9	29.93	100.71
93270	2	731	93270	EKG / ECG - HOLTER MONITOR		111.9
93270	3
93306	1	1		COMPLETE TRANSTHORACIC ECHOCARDIOGRAM (TTE)	OUT	2193.2	1315.92	1864.22	148.77	1250.12	1140.46	1346.62	1754.56	1272.06	1272.06	1272.06	1272.06	1272.06	1272.06	1272.06	1973.88	591	1973.88	175.72	1272.06	1272.06	148.77	1973.88
93306	2	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
93306	3
93306/93880	1	1		TRANSTHORACIC ECHO (TTE) WITH CAROTID DUPLEX SCAN	OUT	3160.1	1896.06	2686.09	257.12	1801.25	1643.25	1940.3	2528.08	1832.86	1832.86	1832.86	1832.86	1832.86	1832.86	1832.86	2844.09	851.55	2844.09	245.35	1832.86	1832.86	245.35	2844.09
93306/93880	2	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
93306/93880	3	921	93880	PERIPHERAL VASCULAR LAB		966.9
93306/93880	4
93306/93923	1	1		TRANSTHORACIC ECHO (TTE) WITH ARTERIAL STUDY	OUT	2819	1691.4	2396.15	215.86	1606.83	1465.88	1730.86	2255.2	1635.02	1635.02	1635.02	1635.02	1635.02	1635.02	1635.02	2537.1	759.63	2537.1	224.59	1635.02	1635.02	215.86	2537.1
93306/93923	2	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
93306/93923	3	920	93923	OTHER DIAGNOSTIC SERVICES		625.8
93306/93923	4
93306/93970	1	1		TRANSTHORACIC ECHO (TTE) WITH VEIN DUPLEX SCAN	OUT	3160.1	1896.06	2686.09	257.12	1801.25	1643.25	1940.3	2528.08	1832.86	1832.86	1832.86	1832.86	1832.86	1832.86	1832.86	2844.09	851.55	2844.09	245.35	1832.86	1832.86	245.35	2844.09
93306/93970	2	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
93306/93970	3	921	93970	PERIPHERAL VASCULAR LAB		966.9
93306/93970	4
93306/93976	1	1		TRANSTHORACIC ECHO (TTE) W ABDOMINAL DUPLEX SCAN	OUT	2712	1627.2	2305.2	257.12	1545.84	1410.24	1665.16	2169.6	1572.96	1572.96	1572.96	1572.96	1572.96	1572.96	1572.96	2440.8	730.8	2440.8	245.35	1572.96	1572.96	245.35	2440.8
93306/93976	2	483	93306	CARDIOLOGY - ECHOCARDIOLOGY		2193.2
93306/93976	3	921	93976	PERIPHERAL VASCULAR LAB		518.8
93306/93976	4
93452	1	1		INSERT CATHETER INTO LEFT HEART NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
93452	2
93797	1	1		CARDIAC REHAB 1 OUTPATIENT SESSION NO ECG MONITOR	OUT	377.7	226.62	321.05	15.24	215.29	196.4	231.91	302.16	109.53	109.53	109.53	109.53	109.53	109.53	109.53	339.93	101.78	339.93	35.96	109.53	109.53	15.24	339.93
93797	2	943	93797	CARDIAC REHABILITATION		377.7
93797	3
93798	1	1		CARDIAC REHAB 1 OUTPATIENT SESSION WITH ECG MONITR	OUT	755.5	453.3	642.18	24.53	430.64	392.86	463.88	604.4	438.19	438.19	438.19	438.19	438.19	438.19	438.19	679.95	203.58	679.95	35.96	438.19	438.19	24.53	679.95
93798	2	943	93798	CARDIAC REHABILITATION		755.5
93798	3
94010	1	1		LUNG TESTING SPIROMETRY DIFFUSION AND VOLUME	OUT	1086.1	651.66	923.19	71.43	619.08	564.78	666.86	868.88	629.94	629.94	629.94	629.94	629.94	629.94	629.94	977.49	292.67	977.49	76.86	629.94	629.94	71.43	977.49
94010	2	460	94010	PULMONARY - GENERAL		469.4
94010	3	460	94727	PULMONARY - GENERAL		469.4
94010	4	460	94729	PULMONARY - GENERAL		147.3
94010	5
94060	1	1		LUNG TESTING BRONCHODILATOR DIFFUSION AND VOLUME	OUT	1550.9	930.54	1318.27	86.97	884.01	806.47	952.25	1240.72	899.52	899.52	899.52	899.52	899.52	899.52	899.52	1395.81	417.92	1395.81	93.99	899.52	899.52	86.97	1395.81
94060	2	460	94060	PULMONARY - GENERAL		934.2
94060	3	460	94727	PULMONARY - GENERAL		469.4
94060	4	460	94729	PULMONARY - GENERAL		147.3
94060	5
94625	1	1		PULOMONARY REHAB VISIT WITHOUT OXIMETRY MONITORING	OUT	204	122.4	173.4	51.94	116.28	106.08	125.26	163.2	118.32	118.32	118.32	118.32	118.32	118.32	118.32	183.6	54.97	183.6	25.58	118.32	118.32	25.58	183.6
94625	2	460	94625	PULMONARY - GENERAL		204
94625	3
94626	1	1		PULOMONARY REHAB VISIT WITH OXIMETRY MONITORING	OUT	223.4	134.04	189.89	59.7	127.34	116.17	137.17	178.72	129.57	129.57	129.57	129.57	129.57	129.57	129.57	201.06	60.2	201.06	25.58	129.57	129.57	25.58	201.06
94626	2	460	94626	PULMONARY - GENERAL		223.4
94626	3
95806	1	1		SLEEP STUDY UNATTENDED	OUT	625.8	375.48	531.93	150.07	356.71	325.42	384.24	500.64	362.96	362.96	362.96	362.96	362.96	362.96	362.96	563.22	168.63	563.22	77.67	362.96	362.96	77.67	563.22
95806	2	920	95806	OTHER DIAGNOSTIC SERVICES		625.8
95806	3
95810	1	1		SLEEP STUDY ATTENDED BY A TECHNOLOGIST	OUT	4069.6	2441.76	3459.16	156.45	2319.67	2116.19	2498.73	3255.68	2360.37	2360.37	2360.37	2360.37	2360.37	2360.37	2360.37	3662.64	1096.63	3662.64	362.76	2360.37	2360.37	156.45	3662.64
95810	2	920	95810	OTHER DIAGNOSTIC SERVICES		4069.6
95810	3
95811	1	1		SLEEP STUDY ATTENDED WITH CPAP TITRATION	OUT	4096.6	2457.96	3482.11	209.96	2335.06	2130.23	2515.31	3277.28	2376.03	2376.03	2376.03	2376.03	2376.03	2376.03	2376.03	3686.94	1103.9	3686.94	362.76	2376.03	2376.03	209.96	3686.94
95811	2	920	95811	OTHER DIAGNOSTIC SERVICES		4096.6
95811	3
97110	1	1		PHYSICAL THERAPY THERAPEUTIC EXERCISE 30 MINUTES	OUT	163.2	97.92	138.72	40.6	93.02	84.86	80	130.56	94.66	94.66	94.66	94.66	94.66	94.66	94.66	146.88	43.98	146.88	40	94.66	94.66	40	146.88
97110	2	420	97110	PHYSICAL THERAPY - GENERAL		163.2
97110	3
97112	1	1		PHYSICAL THERAPY NEUROMUSCULAR REEDUCATION 15 MIN	OUT	90.8	54.48	77.18	15.11	51.76	47.22	80	72.64	52.66	52.66	52.66	52.66	52.66	52.66	52.66	81.72	24.47	81.72	40	52.66	52.66	15.11	81.72
97112	2	420	97112	PHYSICAL THERAPY - GENERAL		90.8
97112	3
97116	1	1		PHYSICAL THERAPY GAIT TRAINING (INC STAIRS) 15 MIN	OUT	81.6	48.96	69.36	13.24	46.51	42.43	80	65.28	47.33	47.33	47.33	47.33	47.33	47.33	47.33	73.44	21.99	73.44	40	47.33	47.33	13.24	80
97116	2	420	97116	PHYSICAL THERAPY - GENERAL		81.6
97116	3
97140	1	1		PHYSICAL THERAPY MANUAL MANIPULATION EACH 15 MIN	OUT	83.1	49.86	70.64	19.99	47.37	43.21	80	66.48	48.2	48.2	48.2	48.2	48.2	48.2	48.2	74.79	22.39	74.79	40	48.2	48.2	19.99	80
97140	2	420	97140	PHYSICAL THERAPY - GENERAL		83.1
97140	3
97161	1	1		PHYSICAL THERAPY EVALUATION LOW COMPLEXITY	OUT	277.6	166.56	235.96	66.74	158.23	144.35	80	222.08	161.01	161.01	161.01	161.01	161.01	161.01	161.01	249.84	74.8	249.84	40	161.01	161.01	40	249.84
97161	2	424	97161	PHYSICAL THERAPY - EVAL / RE-EVAL		277.6
97161	3
97162	1	1		PHYSICAL THERAPY EVALUATION MODERATE COMPLEXITY	OUT	277.6	166.56	235.96	66.74	158.23	144.35	80	222.08	161.01	161.01	161.01	161.01	161.01	161.01	161.01	249.84	74.8	249.84	40	161.01	161.01	40	249.84
97162	2	424	97162	PHYSICAL THERAPY - EVAL / RE-EVAL		277.6
97162	3
97165	1	1		OCCUPATIONAL THERAPY EVALUATION LOW COMPLEXITY	OUT	284.6	170.76	241.91	64.77	162.22	147.99	80	227.68	165.07	165.07	165.07	165.07	165.07	165.07	165.07	256.14	76.69	256.14	40	165.07	165.07	40	256.14
97165	2	434	97165	OCCUPATIONAL THERAPY - EVAL / RE-EVAL		284.6
97165	3
97530	1	1		PHYSICAL THERAPY THERAPEUTIC ACTIVITY 15 MINUTES	OUT	114.2	68.52	97.07	22.01	65.09	59.38	80	91.36	66.24	66.24	66.24	66.24	66.24	66.24	66.24	102.78	30.77	102.78	40	66.24	66.24	22.01	102.78
97530	2	420	97530	PHYSICAL THERAPY - GENERAL		114.2
97530	3
99203	1	1		NEW PATIENT OFFICE VISIT 30 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99203	2
99204	1	1		NEW PATIENT OFFICE VISIT 45 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99204	2
99205	1	1		NEW PATIENT OFFICE VISIT 60 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99205	2
99243	1	1		PATIENT OFFICE CONSULTATION 40 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99243	2
99244	1	1		PATIENT OFFICE CONSULTATION 60 MIN NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99244	2
99385	1	1		NEW PATIENT PREVENTIVE (18-39 YRS) NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99385	2
99386	1	1		NEW PATIENT PREVENTIVE (40-64 YRS) NOT OFFERED	OUT	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
99386	2
DRG_194	1	1		SIMPLE PNEUMONIA AND PLEURISY WITH CC	IN	21949.72	13169.83	18657.26	1918.09	11760	10820	4029.5	3626.55	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	19754.75	10047.09	19754.75	2644	8857.2	9399.28	1918.09	19754.75
DRG_194	2	120		ROOM & BOARD - SEMI 2 BED		1766.88
DRG_194	3	250		PHARMACY		256.93
DRG_194	4	258		IV SOLUTIONS		83.25
DRG_194	5	270		MED / SUR SUPPLIES & DEVICES		311.13
DRG_194	6	300		LABORATORY		377.07
DRG_194	7	301		LAB - CHEMISTRY		1521.62
DRG_194	8	302		LAB - IMMUNOLOGY		1419.05
DRG_194	9	305		LAB - HEMATOLOGY		324.89
DRG_194	10	306		LAB - BACTERIOLOGY & MICROBIOLOGY		457.09
DRG_194	11	307		LAB - UROLOGY		23.19
DRG_194	12	320		RADIOLOGY - GENERAL		338.91
DRG_194	13	350		CT SCAN - GENERAL		1113.44
DRG_194	14	410		RESPIRATORY SERVICES		7387.66
DRG_194	15	420		PHYSICAL THERAPY - GENERAL		1498.64
DRG_194	16	424		PHYSICAL THERAPY - EVAL / RE-EVAL		298.69
DRG_194	17	430		OCCUPATIONAL THERAPY - GENERAL		962.31
DRG_194	18	434		OCCUPATIONAL THERAPY - EVAL / RE-EVAL		283.13
DRG_194	19	450		EMERGENCY ROOM - GENERAL		2469.12
DRG_194	20	460		PULMONARY - GENERAL		710.1
DRG_194	21	730		EKG / ECG		346.62
DRG_194	22
DRG_216	1	1		MAJOR CARDIOTHORACIC PROCEDURES NOT OFFERED	IN	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
DRG_216	2
DRG_292	1	1		HEART FAILURE AND SHOCK WITH CC	IN	21131.97	12679.18	17962.17	2125.4	11760	10820	4245	3820.5	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	19018.77	9672.78	19018.77	3305	8857.2	9399.28	2125.4	19018.77
DRG_292	2	120		ROOM & BOARD - SEMI 2 BED		1766.88
DRG_292	3	250		PHARMACY		256.93
DRG_292	4	258		IV SOLUTIONS		83.25
DRG_292	5	270		MED / SUR SUPPLIES & DEVICES		311.13
DRG_292	6	300		LABORATORY		377.07
DRG_292	7	301		LAB - CHEMISTRY		1521.62
DRG_292	8	305		LAB - HEMATOLOGY		324.89
DRG_292	9	306		LAB - BACTERIOLOGY & MICROBIOLOGY		457.09
DRG_292	10	307		LAB - UROLOGY		23.19
DRG_292	11	320		RADIOLOGY - GENERAL		338.91
DRG_292	12	410		RESPIRATORY SERVICES		7387.66
DRG_292	13	420		PHYSICAL THERAPY - GENERAL		1498.64
DRG_292	14	424		PHYSICAL THERAPY - EVAL / RE-EVAL		298.69
DRG_292	15	450		EMERGENCY ROOM - GENERAL		2469.12
DRG_292	16	460		PULMONARY - GENERAL		710.1
DRG_292	17	483		CARDIOLOGY - ECHOCARDIOLOGY		2021.04
DRG_292	18	730		EKG / ECG		346.62
DRG_292	19	921		PERIPHERAL VASCULAR LAB		939.14
DRG_292	20
DRG_392	1	1		ESOPHAGITIS GASTROENTERITIS MISC DIGESTIVE DISORDERS	IN	9414.71	5648.83	8002.5	1424.87	9414.71	9414.71	3898	3508.2	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	8473.24	4309.41	8473.24	2644	8857.2	9399.28	1424.87	9414.71
DRG_392	2	120		ROOM & BOARD - SEMI 2 BED		1766.88
DRG_392	3	250		PHARMACY		256.93
DRG_392	4	258		IV SOLUTIONS		83.25
DRG_392	5	270		MED / SUR SUPPLIES & DEVICES		311.13
DRG_392	6	300		LABORATORY		377.07
DRG_392	7	301		LAB - CHEMISTRY		1521.62
DRG_392	8	305		LAB - HEMATOLOGY		324.89
DRG_392	9	306		LAB - BACTERIOLOGY & MICROBIOLOGY		457.09
DRG_392	10	307		LAB - UROLOGY		23.19
DRG_392	11	350		CT SCAN - GENERAL		1113.44
DRG_392	12	450		EMERGENCY ROOM - GENERAL		2469.12
DRG_392	13	460		PULMONARY - GENERAL		710.1
DRG_392	14
DRG_460	1	1		SPINAL FUSION EXCEPT CERVICAL NOT OFFERED	IN	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
DRG_460	2
DRG_470	1	1		MAJOR JOINT REPLACEMENT NOT OFFERED	IN	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
DRG_470	2
DRG_473	1	1		CERVIAL SPINAL FUSION NOT OFFERED	IN	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
DRG_473	2
DRG_690	1	1		KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC	IN	10529.72	6317.83	8950.26	1345.33	10529.72	10529.72	4047.5	3642.75	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	8857.2	9476.75	4819.79	9476.75	2644	8857.2	9399.28	1345.33	10529.72
DRG_690	2	120		ROOM & BOARD - SEMI 2 BED		1766.88
DRG_690	3	250		PHARMACY		256.93
DRG_690	4	258		IV SOLUTIONS		83.25
DRG_690	5	300		LABORATORY		377.07
DRG_690	6	301		LAB - CHEMISTRY		1521.62
DRG_690	7	305		LAB - HEMATOLOGY		324.89
DRG_690	8	306		LAB - BACTERIOLOGY & MICROBIOLOGY		457.09
DRG_690	9	307		LAB - UROLOGY		23.19
DRG_690	10	320		RADIOLOGY - GENERAL		338.91
DRG_690	11	350		CT SCAN - GENERAL		1113.44
DRG_690	12	420		PHYSICAL THERAPY - GENERAL		1498.64
DRG_690	13	424		PHYSICAL THERAPY - EVAL / RE-EVAL		298.69
DRG_690	14	450		EMERGENCY ROOM - GENERAL		2469.12
DRG_690	15
DRG_743	1	1		UTERINE AND ADNEXA PROCEDURES NOT OFFERED	IN	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
DRG_743	2
G0105	1	1		COLORECTAL COLONOSCOPY SCREEN HIGH RISK INDIVIDUAL	OUT	2249.48	1349.69	1912.06	662.97	2249.48	2249.48	752	1799.58	652.35	652.35	652.35	652.35	652.35	652.35	652.35	2024.53	606.16	2024.53	347	652.35	652.35	347	2249.48
G0105	2	250		PHARMACY		256.93
G0105	3	258		IV SOLUTIONS		83.25
G0105	4	370		ANESTHESIA		135.65
G0105	5	710		RECOVERY ROOM - GENERAL		336.15
G0105	6	750	G0105	GASTROINTESTINAL SERVICES - GENERAL		1437.5
G0105	7
G0121	1	1		COLORECTAL COLONOSCOPY SCREEN NOT HIGH RISK INDIVI	OUT	1852.35	1111.41	1574.5	495.2	1852.35	1852.35	752	1481.88	1074.36	1074.36	1074.36	1074.36	1074.36	1074.36	1074.36	1667.12	499.15	1667.12	347	1074.36	1074.36	347	1852.35
G0121	2	258		IV SOLUTIONS		83.25
G0121	3	370		ANESTHESIA		135.65
G0121	4	710		RECOVERY ROOM - GENERAL		336.15
G0121	5	750	G0121	GASTROINTESTINAL SERVICES - GENERAL		1297.3
G0121	6
G0283	1	1		PHYSICAL THERAPY ELECTRIC STIMULATION UNATTENDED	OUT	34.5	20.7	29.33	0	19.67	17.94	34.5	27.6	20.01	20.01	20.01	20.01	20.01	20.01	20.01	31.05	9.3	31.05	34.5	20.01	20.01	9.3	34.5
G0283	2	420	G0283	PHYSICAL THERAPY - GENERAL		34.5
G0283	3

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