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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Richard Medical Center,2024-03-08,2.0.0,Richard Medical Center,"254 Highway 3048 Bayville, LA 71269",721179028|LA,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AMERIHEALTH PLAN,AMERIHEALTH REIMBURSEMENT METHOD,BCBS HMO PLAN,BCBS HMO REIMBURSEMENT METHOD,BCBS PPO PLAN,BCBS PPO REIMBURSEMENT METHOD,BCBS TRADITIONAL PLAN,BCBS TRADITIONAL REIMBURSEMENT METHOD,BCBS MEDICARE PLAN,BCBS MEDICARE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,COVENTRY HMO PLAN,COVENTRY HMO REIMBURSEMENT METHOD,COVENTRY POS PLAN,COVENTRY POS REIMBURSEMENT METHOD,COVENTRY PPO PLAN,COVENTRY PPO REIMBURSEMENT METHOD,COVENTRY ASO PLAN,COVENTRY ASO REIMBURSEMENT METHOD,COVENTRY OPM PLAN,COVENTRY OPM REIMBURSEMENT METHOD,COVENTRY NETWORK ACCESS PLAN,COVENTRY NETWORK ACCESS REIMBURSEMENT METHOD,GILSBAR PPO PLAN,GILSBAR PPO REIMBURSEMENT METHOD,HUMANA EPO PLAN,HUMANA EPO REIMBURSEMENT METHOD,HUMANA HMO PLAN,HUMANA HMO REIMBURSEMENT METHOD,HUMANA POS PLAN,HUMANA POS REIMBURSEMENT METHOD,HUMANA PPO PLAN,HUMANA PPO REIMBURSEMENT METHOD,HUMANA MEDICARE HMO PLAN,HUMANA MEDICARE HMO REIMBURSEMENT METHOD,HUMANA MEDICARE POS PLAN,HUMANA MEDICARE POS REIMBURSEMENT METHOD,HUMANA MEDICARE PPO PLAN,HUMANA MEDICARE PPO REIMBURSEMENT METHOD,LA HEALTHCARE CONNECTIONS PLAN,LA HEALTHCARE CONNECTIONS REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MULTIPLAN PLAN,MULTIPLAN REIMBURSEMENT METHOD,PEOPLES HEALTH NETWORK PLAN,PEOPLES HEALTH NETWORK REIMBURSEMENT METHOD,PPO PLUS PLAN,PPO PLUS REIMBURSEMENT METHOD,PPO PLUS EMPLOYEES PLAN,PPO PLUS EMPLOYEES REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICAID PLAN,UHC MEDICAID REIMBURSEMENT METHOD,VANTAGE PLAN,VANTAGE REIMBURSEMENT METHOD,VANTAGE MEDICARE PLAN,VANTAGE MEDICARE REIMBURSEMENT METHOD,VANTAGE METAL PLAN,VANTAGE METAL REIMBURSEMENT METHOD,VERITY PLAN,VERITY REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,AMBULATORY,G0121,COLORECTAL SCREENING ON NON-HIGH RISK PT,490,$998.00 ,$798.40 ,80% of billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,153.12 ",135% BCBS fee schedule for outpatient setting,"$1,153.12 ",135% BCBS fee schedule for outpatient setting,"$1,153.12 ",135% BCBS fee schedule for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$548.90 ,55% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$798.40 ,80% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$798.40 ,80% of total billed charges for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$748.50 ,75% of total billed charges for outpatient setting,$798.40 ,80% of total billed charges for outpatient setting,$798.40 ,80% of total billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,228.22 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,151.46 ",160% CMS Medicare OPPS fee schedule for outpatient setting,$798.40 ,80% of total billed charges for outpatient setting,$468.30 ,"$1,228.22 ",$367.50
Outpatient Medical Services,AMBULATORY,43239,GASTROSCOPY/BIOPSY,490,$929.00 ,$743.20 ,80% of billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.95 ,55% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$743.20 ,80% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$743.20 ,80% of total billed charges for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$696.75 ,75% of total billed charges for outpatient setting,$743.20 ,80% of total billed charges for outpatient setting,$743.20 ,80% of total billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,220.05 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,143.79 ",160% CMS Medicare OPPS fee schedule for outpatient setting,$743.20 ,80% of total billed charges for outpatient setting,$468.30 ,"$1,529.37 ",$367.50
Outpatient Medical Services,AMBULATORY,45378,DIAGNOSTIC COLONOSCOPY,510,$750.00 ,$600.00 ,80% of billed charges for outpatient setting,$301.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.50 ,55% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$600.00 ,80% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$716.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$301.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$301.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$600.00 ,80% of total billed charges for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$562.50 ,75% of total billed charges for outpatient setting,$600.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$301.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,228.22 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$767.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,151.46 ",160% CMS Medicare OPPS fee schedule for outpatient setting,$600.00 ,80% of total billed charges for outpatient setting,$301.80 ,"$1,622.75 ",$382.50
Outpatient Medical Services,AMBULATORY,45380,COLONOSCOPY W/BIOPSY,510,$852.00 ,$681.60 ,80% of billed charges for outpatient setting,$342.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$468.60 ,55% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$681.60 ,80% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$342.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$342.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$681.60 ,80% of total billed charges for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$639.00 ,75% of total billed charges for outpatient setting,$681.60 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$342.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,600.47 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,500.43 ",160% CMS Medicare OPPS fee schedule for outpatient setting,$681.60 ,80% of total billed charges for outpatient setting,$342.84 ,"$1,622.75 ",$382.50
Outpatient Medical Services,AMBULATORY,45384,COLON/POLYP/BIOPSY,490,"$1,689.00 ","$1,351.20 ",80% of billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$928.95 ,55% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,351.20 ",80% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,351.20 ",80% of total billed charges for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,266.75 ",75% of total billed charges for outpatient setting,"$1,351.20 ",80% of total billed charges for outpatient setting,"$1,351.20 ",80% of total billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,600.47 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,500.43 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,351.20 ",80% of total billed charges for outpatient setting,$468.30 ,"$1,622.75 ",$367.50
Outpatient Medical Services,AMBULATORY,45385,COLON/FLEXIBLE W/ ABLATION,490,"$1,959.58 ","$1,567.66 ",80% of billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,622.75 ",135% BCBS ASC fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,077.77 ",55% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,567.66 ",80% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$933.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,567.66 ",80% of total billed charges for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,469.69 ",75% of total billed charges for outpatient setting,"$1,567.66 ",80% of total billed charges for outpatient setting,"$1,567.66 ",80% of total billed charges for outpatient setting,$468.30 ,100% LA Medicaid ASC rate for outpatient setting,"$1,600.47 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,000.29 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,500.43 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,567.66 ",80% of total billed charges for outpatient setting,$468.30 ,"$1,622.75 ",$367.50
Outpatient Medical Services,AMBULATORY,43235,GASTROSCOPY,490,"$1,072.00 ",$857.60 ,80% of billed charges for outpatient setting,$349.65 ,100% LA Medicaid ASC rate for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,"$1,529.37 ",135% BCBS ASC fee schedule for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$589.60 ,55% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$857.60 ,80% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$711.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$349.65 ,100% LA Medicaid ASC rate for outpatient setting,$349.65 ,100% LA Medicaid ASC rate for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$857.60 ,80% of total billed charges for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$804.00 ,75% of total billed charges for outpatient setting,$857.60 ,80% of total billed charges for outpatient setting,$857.60 ,80% of total billed charges for outpatient setting,$349.65 ,100% LA Medicaid ASC rate for outpatient setting,"$1,220.05 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$762.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,143.79 ",160% CMS Medicare OPPS fee schedule for outpatient setting,$857.60 ,80% of total billed charges for outpatient setting,$349.65 ,"$1,529.37 ",$367.50
Outpatient Medical Services,AMBULATORY,47562,LAPAROSCOPIC CHOLECYSTECTOMY,360,"$5,766.00 ","$4,612.80 ",80% of billed charges for outpatient setting,"$2,320.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$8,162.33 ",135% BCBS ASC fee schedule for outpatient setting,"$8,162.33 ",135% BCBS ASC fee schedule for outpatient setting,"$8,162.33 ",135% BCBS ASC fee schedule for outpatient setting,"$4,814.53 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,171.30 ",55% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$4,612.80 ",80% of total billed charges for outpatient setting,"$4,324.50 ",75% of total billed charges for outpatient setting,"$4,324.50 ",75% of total billed charges for outpatient setting,"$4,324.50 ",75% of total billed charges for outpatient setting,"$4,324.50 ",75% of total billed charges for outpatient setting,"$4,495.35 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,495.35 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,495.35 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,320.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,320.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,814.53 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,612.80 ",80% of total billed charges for outpatient setting,"$4,814.53 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,324.50 ",75% of total billed charges for outpatient setting,"$4,612.80 ",80% of total billed charges for outpatient setting,"$4,612.80 ",80% of total billed charges for outpatient setting,"$2,320.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$7,703.27 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$4,814.53 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$4,612.80 ",80% of total billed charges for outpatient setting,"$2,320.24 ","$8,162.33 ",$270.00
Outpatient Medical Services,AMBULATORY,10120,INCISION/REMOVAL FOREIGN BODY SIMPLE,361,$700.00 ,$560.00 ,80% of billed charges for outpatient setting,$281.68 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$718.61 ,135% BCBS ASC fee schedule for outpatient setting,$718.61 ,135% BCBS ASC fee schedule for outpatient setting,$718.61 ,135% BCBS ASC fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$385.00 ,55% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$560.00 ,80% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$281.68 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$281.68 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$560.00 ,80% of total billed charges for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$525.00 ,75% of total billed charges for outpatient setting,$560.00 ,80% of total billed charges for outpatient setting,$560.00 ,80% of total billed charges for outpatient setting,$281.68 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$551.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$516.90 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$560.00 ,80% of total billed charges for outpatient setting,$281.68 ,$718.61 ,$270.75
Outpatient Medical Services,AMBULATORY,11401,EXCIS BENIGN LESION-TRUCK EXTEM 0.6-1.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$551.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$516.90 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,$786.48 ,$270.00
Outpatient Medical Services,AMBULATORY,11402,EXCIS BENIGN LESION-TRUCK EXTEM 1.1-2.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,$959.13 ,$270.00
Outpatient Medical Services,AMBULATORY,11403,EXCIS BENIGN LESION-TRUNK EXTEM 2.1-3.0,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11404,EXCIS BENIGN LESION-TRUNK EXTEM 3.1-4.0,360,"$2,179.00 ","$1,743.20 ",80% of billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,198.45 ",55% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,"$2,843.72 ",$270.00
Outpatient Medical Services,AMBULATORY,19083,US GUIDED NEEDLE PLAC BREAST BX,360,"$2,486.00 ","$1,988.80 ",80% of billed charges for outpatient setting,"$1,000.37 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$829.93 ,135% BCBS ASC fee schedule for outpatient setting,$829.93 ,135% BCBS ASC fee schedule for outpatient setting,$829.93 ,135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,367.30 ",55% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,988.80 ",80% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,000.37 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,000.37 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,988.80 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,864.50 ",75% of total billed charges for outpatient setting,"$1,988.80 ",80% of total billed charges for outpatient setting,"$1,988.80 ",80% of total billed charges for outpatient setting,"$1,000.37 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,988.80 ",80% of total billed charges for outpatient setting,$829.93 ,"$2,216.25 ",$270.00
Outpatient Medical Services,AMBULATORY,58150,TOTAL ABDOMINAL HYSERECTOMY,360,"$6,000.00 ","$4,800.00 ",80% of billed charges for outpatient setting,"$2,414.40 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,300.00 ",55% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$4,800.00 ",80% of total billed charges for outpatient setting,"$4,500.00 ",75% of total billed charges for outpatient setting,"$4,500.00 ",75% of total billed charges for outpatient setting,"$4,500.00 ",75% of total billed charges for outpatient setting,"$4,500.00 ",75% of total billed charges for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,414.40 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,414.40 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,800.00 ",80% of total billed charges for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$4,500.00 ",75% of total billed charges for outpatient setting,"$4,800.00 ",80% of total billed charges for outpatient setting,"$4,800.00 ",80% of total billed charges for outpatient setting,"$2,414.40 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$6,000.00 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$6,000.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$6,000.00 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$4,800.00 ",80% of total billed charges for outpatient setting,"$2,414.40 ","$6,000.00 ",$270.00
Outpatient Medical Services,AMBULATORY,58180,SUPRACERVICAL ABD HYSTERECTOMY ASSISTING,360,"$3,163.00 ","$2,530.40 ",80% of billed charges for outpatient setting,"$1,272.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,739.65 ",55% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,530.40 ",80% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,272.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,272.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,530.40 ",80% of total billed charges for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,372.25 ",75% of total billed charges for outpatient setting,"$2,530.40 ",80% of total billed charges for outpatient setting,"$2,530.40 ",80% of total billed charges for outpatient setting,"$1,272.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,163.00 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$3,163.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,163.00 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,530.40 ",80% of total billed charges for outpatient setting,"$1,272.79 ","$3,218.62 ",$270.00
Outpatient Medical Services,AMBULATORY,19120,EXCIS BREAST LESION (WO RADIOLOGY),360,"$3,084.00 ","$2,467.20 ",80% of billed charges for outpatient setting,"$1,241.00 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,684.92 ",135% BCBS ASC fee schedule for outpatient setting,"$3,684.92 ",135% BCBS ASC fee schedule for outpatient setting,"$3,684.92 ",135% BCBS ASC fee schedule for outpatient setting,"$3,175.54 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,696.20 ",55% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,467.20 ",80% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,965.03 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,965.03 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,965.03 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,241.00 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,241.00 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,175.54 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,467.20 ",80% of total billed charges for outpatient setting,"$3,175.54 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,313.00 ",75% of total billed charges for outpatient setting,"$2,467.20 ",80% of total billed charges for outpatient setting,"$2,467.20 ",80% of total billed charges for outpatient setting,"$1,241.00 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,080.87 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$3,175.54 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,467.20 ",80% of total billed charges for outpatient setting,"$1,241.00 ","$5,080.87 ",$270.00
Outpatient Medical Services,AMBULATORY,49505,RPR INITIAL ING HERNIA  REDUCIBLE >5Y,360,"$3,988.00 ","$3,190.40 ",80% of billed charges for outpatient setting,"$1,604.77 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,193.40 ",55% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$3,190.40 ",80% of total billed charges for outpatient setting,"$2,991.00 ",75% of total billed charges for outpatient setting,"$2,991.00 ",75% of total billed charges for outpatient setting,"$2,991.00 ",75% of total billed charges for outpatient setting,"$2,991.00 ",75% of total billed charges for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,604.77 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,604.77 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,190.40 ",80% of total billed charges for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,991.00 ",75% of total billed charges for outpatient setting,"$3,190.40 ",80% of total billed charges for outpatient setting,"$3,190.40 ",80% of total billed charges for outpatient setting,"$1,604.77 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,234.76 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$3,190.40 ",80% of total billed charges for outpatient setting,"$1,604.77 ","$5,430.82 ",$270.00
Outpatient Medical Services,AMBULATORY,49505,PRP I/HERN INIT REDUC>5,360,"$1,735.00 ","$1,388.00 ",80% of billed charges for outpatient setting,$698.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$5,430.82 ",135% BCBS ASC fee schedule for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$954.25 ,55% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,388.00 ",80% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,054.84 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$698.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$698.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,388.00 ",80% of total billed charges for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,301.25 ",75% of total billed charges for outpatient setting,"$1,388.00 ",80% of total billed charges for outpatient setting,"$1,388.00 ",80% of total billed charges for outpatient setting,$698.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,234.76 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$3,271.73 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,388.00 ",80% of total billed charges for outpatient setting,$698.16 ,"$5,430.82 ",$270.00
Outpatient Medical Services,AMBULATORY,58260,UNSP VAGINAL HYSTERECTOMY,521,"$1,500.00 ","$1,200.00 ",80% of billed charges for outpatient setting,$603.60 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$3,218.62 ",135% BCBS ASC fee schedule for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$825.00 ,55% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,200.00 ",80% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$603.60 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$603.60 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,200.00 ",80% of total billed charges for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,125.00 ",75% of total billed charges for outpatient setting,"$1,200.00 ",80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$603.60 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$6,850.42 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,200.00 ",80% of total billed charges for outpatient setting,$603.60 ,"$6,850.42 ",$390.75
Outpatient Medical Services,AMBULATORY,58262,VAG HYST INCLUDING T/O,521,"$2,000.00 ","$1,600.00 ",80% of billed charges for outpatient setting,$804.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,054.14 ",135% BCBS ASC fee schedule for outpatient setting,"$4,054.14 ",135% BCBS ASC fee schedule for outpatient setting,"$4,054.14 ",135% BCBS ASC fee schedule for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,100.00 ",55% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,600.00 ",80% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,997.68 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$804.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$804.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,600.00 ",80% of total billed charges for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,500.00 ",75% of total billed charges for outpatient setting,"$1,600.00 ",80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$804.80 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$6,850.42 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$4,281.51 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,600.00 ",80% of total billed charges for outpatient setting,$804.80 ,"$6,850.42 ",$390.75
Outpatient Medical Services,AMBULATORY,58300,INSERTION INTRAUTERINE DEVICE,361,$690.00 ,$552.00 ,80% of billed charges for outpatient setting,$277.66 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$345.00 ,Not separately reimbursable per CMS guidelines,$379.50 ,55% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$552.00 ,80% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,$517.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$277.66 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$277.66 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$552.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$517.50 ,75% of total billed charges for outpatient setting,$552.00 ,80% of total billed charges for outpatient setting,$552.00 ,80% of total billed charges for outpatient setting,$277.66 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$552.00 ,80% of total billed charges for outpatient setting,$277.66 ,$552.00 ,$270.75
Outpatient Medical Services,AMBULATORY,58301,REMOVAL OF INTRAUTERINE DEVICE,361,$600.00 ,$480.00 ,80% of billed charges for outpatient setting,$241.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$451.36 ,135% BCBS ASC fee schedule for outpatient setting,$269.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$330.00 ,55% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$251.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$251.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$251.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$241.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$241.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$269.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$269.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$450.00 ,75% of total billed charges for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$241.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$431.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$269.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$404.53 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$480.00 ,80% of total billed charges for outpatient setting,$241.44 ,$480.00 ,$270.75
Outpatient Medical Services,AMBULATORY,58600,TUBAL LIGATION  UNI/BILAT,361,"$4,300.00 ","$3,440.00 ",80% of billed charges for outpatient setting,"$1,730.32 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,365.00 ",55% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$3,440.00 ",80% of total billed charges for outpatient setting,"$3,225.00 ",75% of total billed charges for outpatient setting,"$3,225.00 ",75% of total billed charges for outpatient setting,"$3,225.00 ",75% of total billed charges for outpatient setting,"$3,225.00 ",75% of total billed charges for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,730.32 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,730.32 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,440.00 ",80% of total billed charges for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,225.00 ",75% of total billed charges for outpatient setting,"$3,440.00 ",80% of total billed charges for outpatient setting,"$3,440.00 ",80% of total billed charges for outpatient setting,"$1,730.32 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,178.79 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$3,440.00 ",80% of total billed charges for outpatient setting,"$1,730.32 ","$5,080.81 ",$270.75
Outpatient Medical Services,AMBULATORY,58600,TUBAL LIG ABD/VAG UNIL/BIL,360,"$1,200.00 ",$960.00 ,80% of billed charges for outpatient setting,$482.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$5,080.81 ",135% BCBS ASC fee schedule for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$660.00 ,55% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$960.00 ,80% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,438.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$482.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$482.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$960.00 ,80% of total billed charges for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$900.00 ,75% of total billed charges for outpatient setting,$960.00 ,80% of total billed charges for outpatient setting,$960.00 ,80% of total billed charges for outpatient setting,$482.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,178.79 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$2,611.75 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,$960.00 ,80% of total billed charges for outpatient setting,$482.88 ,"$5,080.81 ",$270.00
Outpatient Medical Services,AMBULATORY,11600,EXCIS MAL LESION-TRUNK EXTEM <0.5,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,$959.13 ,$270.00
Outpatient Medical Services,AMBULATORY,11601,EXCIS MAL LESION-TRUNK EXTEM 0.6-1.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,$959.13 ,$270.00
Outpatient Medical Services,AMBULATORY,11602,EXCIS MAL LESION-TRUNK EXTEM 1.1-2.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$551.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$516.90 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,$786.48 ,$270.00
Outpatient Medical Services,AMBULATORY,11602,EXCISION MALIGN LESION 1.1 TO 2 CM,360,$527.00 ,$421.60 ,80% of billed charges for outpatient setting,$212.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$289.85 ,55% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$421.60 ,80% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$212.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$212.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$421.60 ,80% of total billed charges for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$395.25 ,75% of total billed charges for outpatient setting,$421.60 ,80% of total billed charges for outpatient setting,$421.60 ,80% of total billed charges for outpatient setting,$212.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$551.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$516.90 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$421.60 ,80% of total billed charges for outpatient setting,$212.06 ,$786.48 ,$270.00
Outpatient Medical Services,AMBULATORY,11603,EXCIS MAL LESION-TRUNK EXTEM 2.1-3.0,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11604,EXCIS MAL LESION-TRUNK EXTEM 3.1-4.0,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11606,EXCIS MAL LESION-TRUNK EXTEM >4.0,360,"$2,179.00 ","$1,743.20 ",80% of billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,198.45 ",55% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,"$2,843.72 ",$270.00
Outpatient Medical Services,AMBULATORY,11620,EXCIS MAL LESION-HEAD FEET GEN <0.5,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$2,216.25 ",$270.00
Outpatient Medical Services,AMBULATORY,11621,EXCIS MAL LESION-HEAD FEET GEN 0.6-1.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$786.48 ,135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,$959.13 ,$270.00
Outpatient Medical Services,AMBULATORY,11622,EXCIS MAL LESION-HEAD FEET GEN 1.1-2.0,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11623,EXCIS MAL LESION-HEAD FEET GEN 2.1-3.0,360,"$2,179.00 ","$1,743.20 ",80% of billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,198.45 ",55% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,"$2,843.72 ",$270.00
Outpatient Medical Services,AMBULATORY,11624,EXCISION LESION 3.1CM TO 4.0CM,360,"$2,600.00 ","$2,080.00 ",80% of billed charges for outpatient setting,"$1,046.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,430.00 ",55% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$2,080.00 ",80% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,046.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,046.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,080.00 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,950.00 ",75% of total billed charges for outpatient setting,"$2,080.00 ",80% of total billed charges for outpatient setting,"$2,080.00 ",80% of total billed charges for outpatient setting,"$1,046.24 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,080.00 ",80% of total billed charges for outpatient setting,"$1,046.24 ","$2,843.72 ",$270.00
Outpatient Medical Services,AMBULATORY,11626,EXCIS MAL LESION-HEAD FEET GEN >4.0,360,"$2,880.00 ","$2,304.00 ",80% of billed charges for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,584.00 ",55% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,817.90 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$1,158.91 ","$3,817.90 ",$270.00
Outpatient Medical Services,AMBULATORY,11640,EXCIS MAL LESION-FACE <0.5,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11641,EXCIS MAL LESION-FACE 0.6-1.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11642,EXCIS MAL LESION-FACE 1.1-2.0,360,$613.00 ,$490.40 ,80% of billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$337.15 ,55% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$559.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$459.75 ,75% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$959.13 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$599.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$899.19 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$490.40 ,80% of total billed charges for outpatient setting,$246.67 ,"$1,316.03 ",$270.00
Outpatient Medical Services,AMBULATORY,11643,EXCIS MAL LESION-FACE 2.1-3.0,360,"$1,024.00 ",$819.20 ,80% of billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,316.03 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$563.20 ,55% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$768.00 ,75% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,$819.20 ,80% of total billed charges for outpatient setting,$412.06 ,"$2,216.25 ",$270.00
Outpatient Medical Services,AMBULATORY,11644,EXCIS MAL LESION-FACE 3.1-4.0,360,"$2,179.00 ","$1,743.20 ",80% of billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$2,843.72 ",135% BCBS ASC fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,198.45 ",55% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,293.33 ",100% CMS Medicare OPPS fee schedule for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,634.25 ",75% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,216.25 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$1,385.15 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,743.20 ",80% of total billed charges for outpatient setting,$876.83 ,"$2,843.72 ",$270.00
Outpatient Medical Services,AMBULATORY,11646,EXCIS MAL LESION-FACE >4.0,360,"$2,880.00 ","$2,304.00 ",80% of billed charges for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$3,710.83 ",135% BCBS ASC fee schedule for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,584.00 ",55% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,228.00 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,160.00 ",75% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$1,158.91 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,817.90 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$2,386.17 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,304.00 ",80% of total billed charges for outpatient setting,"$1,158.91 ","$3,817.90 ",$270.00
Outpatient Medical Services,AMBULATORY,11100,BIOPSY OF SKIN SINGLE LESION,361,$393.00 ,$314.40 ,80% of billed charges for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$196.50 ,50% of total billed charges for outpatient setting,$196.50 ,50% of total billed charges for outpatient setting,$196.50 ,50% of total billed charges for outpatient setting,$196.50 ,Not separately reimbursable per CMS guidelines,$216.15 ,55% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$314.40 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$314.40 ,80% of total billed charges for outpatient setting,$158.14 ,$314.40 ,$270.75
Outpatient Medical Services,AMBULATORY,11101,BIOSPY OF SKIN EACH ADD LESION,361,$150.00 ,$120.00 ,80% of billed charges for outpatient setting,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.00 ,50% of total billed charges for outpatient setting,$75.00 ,50% of total billed charges for outpatient setting,$75.00 ,50% of total billed charges for outpatient setting,$75.00 ,Not separately reimbursable per CMS guidelines,$82.50 ,55% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$120.00 ,80% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$120.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$112.50 ,75% of total billed charges for outpatient setting,$120.00 ,80% of total billed charges for outpatient setting,$120.00 ,80% of total billed charges for outpatient setting,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$120.00 ,80% of total billed charges for outpatient setting,$60.36 ,$120.00 ,$270.75
Outpatient Medical Services,AMBULATORY,11102,BX SKIN SINGLE LESION,360,$210.00 ,$168.00 ,80% of billed charges for outpatient setting,$84.50 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$166.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$115.50 ,55% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$168.00 ,80% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$155.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$84.50 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$84.50 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$168.00 ,80% of total billed charges for outpatient setting,$166.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$157.50 ,75% of total billed charges for outpatient setting,$168.00 ,80% of total billed charges for outpatient setting,$168.00 ,80% of total billed charges for outpatient setting,$84.50 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.87 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.79 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$250.20 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$168.00 ,80% of total billed charges for outpatient setting,$84.50 ,$562.17 ,$270.00
Outpatient Medical Services,AMBULATORY,11103,BX SKIN EACH SEPERATE/ADDITIONAL LESION,360,$175.00 ,$140.00 ,80% of billed charges for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$169.43 ,135% BCBS ASC fee schedule for outpatient setting,$169.43 ,135% BCBS ASC fee schedule for outpatient setting,$169.43 ,135% BCBS ASC fee schedule for outpatient setting,$87.50 ,Not separately reimbursable per CMS guidelines,$96.25 ,55% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$140.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$140.00 ,80% of total billed charges for outpatient setting,$70.42 ,$169.43 ,$270.00
Outpatient Medical Services,AMBULATORY,11104,PUNCH BIOPSY OF SKIN SINGLE LESION,361,$393.00 ,$314.40 ,80% of billed charges for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$562.17 ,135% BCBS ASC fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$216.15 ,55% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$551.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$344.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$516.90 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$158.14 ,$562.17 ,$270.75
Outpatient Medical Services,AMBULATORY,11105,PUNCH BIOPSY EACH ADDL LESION,361,$186.00 ,$148.80 ,80% of billed charges for outpatient setting,$74.85 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$194.41 ,135% BCBS ASC fee schedule for outpatient setting,$194.41 ,135% BCBS ASC fee schedule for outpatient setting,$194.41 ,135% BCBS ASC fee schedule for outpatient setting,$93.00 ,Not separately reimbursable per CMS guidelines,$102.30 ,55% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$148.80 ,80% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,$139.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$74.85 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$74.85 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$148.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$139.50 ,75% of total billed charges for outpatient setting,$148.80 ,80% of total billed charges for outpatient setting,$148.80 ,80% of total billed charges for outpatient setting,$74.85 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$148.80 ,80% of total billed charges for outpatient setting,$74.85 ,$194.41 ,$270.75
Outpatient Medical Services,CARDIAC,93017,STRESS TEST MEDICATED,482,$692.00 ,$553.60 ,80% of billed charges for outpatient setting,$278.46 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$379.05 ,135% BCBS fee schedule for outpatient setting,$379.05 ,135% BCBS fee schedule for outpatient setting,$379.05 ,135% BCBS fee schedule for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$380.60 ,55% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$553.60 ,80% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$278.46 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$278.46 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$553.60 ,80% of total billed charges for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$519.00 ,75% of total billed charges for outpatient setting,$553.60 ,80% of total billed charges for outpatient setting,$553.60 ,80% of total billed charges for outpatient setting,$278.46 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$413.91 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$388.04 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$553.60 ,80% of total billed charges for outpatient setting,$241.54 ,$553.60 ,$361.50
Outpatient Medical Services,CARDIAC,93017,STRESS TEST NUCLEAR WALKING,482,$471.00 ,$376.80 ,80% of billed charges for outpatient setting,$189.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$379.05 ,135% BCBS fee schedule for outpatient setting,$379.05 ,135% BCBS fee schedule for outpatient setting,$379.05 ,135% BCBS fee schedule for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$259.05 ,55% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$376.80 ,80% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$241.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$189.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$189.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$376.80 ,80% of total billed charges for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$353.25 ,75% of total billed charges for outpatient setting,$376.80 ,80% of total billed charges for outpatient setting,$376.80 ,80% of total billed charges for outpatient setting,$189.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$413.91 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$258.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$388.04 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$376.80 ,80% of total billed charges for outpatient setting,$189.53 ,$413.91 ,$361.50
Outpatient Medical Services,CARDIAC,93005,ELECTROCARDIOGRAM (EKG),730,$142.00 ,$113.60 ,80% of billed charges for outpatient setting,$57.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$57.54 ,135% BCBS fee schedule for outpatient setting,$57.54 ,135% BCBS fee schedule for outpatient setting,$57.54 ,135% BCBS fee schedule for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.10 ,55% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$113.60 ,80% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$57.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$113.60 ,80% of total billed charges for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$106.50 ,75% of total billed charges for outpatient setting,$113.60 ,80% of total billed charges for outpatient setting,$113.60 ,80% of total billed charges for outpatient setting,$57.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$84.95 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.64 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$113.60 ,80% of total billed charges for outpatient setting,$49.57 ,$113.60 ,$547.50
Outpatient Medical Services,CARDIAC,93242,HOLTER EPATCH HOOKUP 3-7 DAYS,731,$102.00 ,$81.60 ,80% of billed charges for outpatient setting,$41.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$86.81 ,135% BCBS fee schedule for outpatient setting,$86.81 ,135% BCBS fee schedule for outpatient setting,$86.81 ,135% BCBS fee schedule for outpatient setting,$31.36 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.10 ,55% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$29.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$41.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$31.36 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$31.36 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$41.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$50.19 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$31.36 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.05 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$29.28 ,$86.81 ,$548.25
Outpatient Medical Services,CARDIAC,93246,HOLTER EPATCH HOOKUP 8-14 DAYS,731,$133.00 ,$106.40 ,80% of billed charges for outpatient setting,$53.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$142.76 ,135% BCBS fee schedule for outpatient setting,$142.76 ,135% BCBS fee schedule for outpatient setting,$142.76 ,135% BCBS fee schedule for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.15 ,55% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$106.40 ,80% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$53.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$106.40 ,80% of total billed charges for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.75 ,75% of total billed charges for outpatient setting,$106.40 ,80% of total billed charges for outpatient setting,$106.40 ,80% of total billed charges for outpatient setting,$53.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$84.95 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$53.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.64 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$106.40 ,80% of total billed charges for outpatient setting,$49.57 ,$142.76 ,$548.25
Outpatient Medical Services,CARDIAC,93000,EKG WITH INTERPRETATION,730,$80.00 ,$64.00 ,80% of billed charges for outpatient setting,$32.19 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$124.29 ,135% BCBS fee schedule for outpatient setting,$124.29 ,135% BCBS fee schedule for outpatient setting,$124.29 ,135% BCBS fee schedule for outpatient setting,$40.00 ,Not separately reimbursable per CMS guidelines,$44.00 ,55% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$32.19 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$32.19 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$64.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$60.00 ,75% of total billed charges for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$32.19 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$64.00 ,80% of total billed charges for outpatient setting,$32.19 ,$124.29 ,$547.50
Outpatient Medical Services,CARDIAC,93453,RT & LT HEART CATH,480,"$9,500.00 ","$7,600.00 ",80% of billed charges for outpatient setting,"$3,822.80 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$8,687.74 ",135% BCBS fee schedule for outpatient setting,"$8,687.74 ",135% BCBS fee schedule for outpatient setting,"$8,687.74 ",135% BCBS fee schedule for outpatient setting,"$2,732.77 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$5,225.00 ",55% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$2,500.00 ",75% of total billed charges for outpatient setting,"$7,600.00 ",80% of total billed charges for outpatient setting,"$7,125.00 ",75% of total billed charges for outpatient setting,"$7,125.00 ",75% of total billed charges for outpatient setting,"$7,125.00 ",75% of total billed charges for outpatient setting,"$7,125.00 ",75% of total billed charges for outpatient setting,"$2,551.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,551.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,551.61 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$3,822.80 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$3,822.80 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,732.77 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$7,600.00 ",80% of total billed charges for outpatient setting,"$2,732.77 ",100% CMS Medicare OPPS fee schedule for outpatient setting,"$7,125.00 ",75% of total billed charges for outpatient setting,"$7,600.00 ",80% of total billed charges for outpatient setting,"$7,600.00 ",80% of total billed charges for outpatient setting,"$3,822.80 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$4,372.43 ",140% CMS Medicare OPPS fee schedule for outpatient setting,"$2,732.77 ",100% CMS Medicare OPPS fee schedule for outpatient setting,N/A,160% CMS Medicare OPPS fee schedule for outpatient setting,"$7,600.00 ",80% of total billed charges for outpatient setting,"$2,500.00 ","$8,687.74 ",$360.00
Outpatient Medical Services,EMERGENCY ROOM,99281,ER LEVEL 1,450,$300.00 ,$240.00 ,80% of billed charges for outpatient setting,$120.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$189.27 ,135% BCBS fee schedule for outpatient setting,$189.27 ,135% BCBS fee schedule for outpatient setting,$189.27 ,135% BCBS fee schedule for outpatient setting,$69.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$165.00 ,55% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$240.00 ,80% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$64.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$120.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$69.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$240.00 ,80% of total billed charges for outpatient setting,$69.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$225.00 ,75% of total billed charges for outpatient setting,$240.00 ,80% of total billed charges for outpatient setting,$240.00 ,80% of total billed charges for outpatient setting,$120.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$110.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$69.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$104.03 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$240.00 ,80% of total billed charges for outpatient setting,$64.76 ,$240.00 ,$337.50
Outpatient Medical Services,EMERGENCY ROOM,99282,ER LEVEL 2,450,$280.00 ,$224.00 ,80% of billed charges for outpatient setting,$112.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$189.27 ,135% BCBS fee schedule for outpatient setting,$189.27 ,135% BCBS fee schedule for outpatient setting,$189.27 ,135% BCBS fee schedule for outpatient setting,$129.03 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$154.00 ,55% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$224.00 ,80% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$120.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$112.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$112.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$129.03 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$224.00 ,80% of total billed charges for outpatient setting,$129.03 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$210.00 ,75% of total billed charges for outpatient setting,$224.00 ,80% of total billed charges for outpatient setting,$224.00 ,80% of total billed charges for outpatient setting,$112.67 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$206.44 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$129.03 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$193.54 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$224.00 ,80% of total billed charges for outpatient setting,$112.67 ,$224.00 ,$337.50
Outpatient Medical Services,EMERGENCY ROOM,99283,ER LEVEL 3,450,$491.00 ,$392.80 ,80% of billed charges for outpatient setting,$197.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$331.34 ,135% BCBS fee schedule for outpatient setting,$331.34 ,135% BCBS fee schedule for outpatient setting,$331.34 ,135% BCBS fee schedule for outpatient setting,$226.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$270.05 ,55% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$392.80 ,80% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$211.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$211.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$197.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$197.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$226.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$392.80 ,80% of total billed charges for outpatient setting,$226.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$368.25 ,75% of total billed charges for outpatient setting,$392.80 ,80% of total billed charges for outpatient setting,$392.80 ,80% of total billed charges for outpatient setting,$197.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$362.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$226.33 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$339.49 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$392.80 ,80% of total billed charges for outpatient setting,$197.58 ,$392.80 ,$337.50
Outpatient Medical Services,EMERGENCY ROOM,99284,ER LEVEL 4,450,$854.00 ,$683.20 ,80% of billed charges for outpatient setting,$343.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$576.56 ,135% BCBS fee schedule for outpatient setting,$576.56 ,135% BCBS fee schedule for outpatient setting,$576.56 ,135% BCBS fee schedule for outpatient setting,$352.49 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$469.70 ,55% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$683.20 ,80% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$329.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$329.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$329.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$343.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$343.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$352.49 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$683.20 ,80% of total billed charges for outpatient setting,$352.49 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$640.50 ,75% of total billed charges for outpatient setting,$683.20 ,80% of total billed charges for outpatient setting,$683.20 ,80% of total billed charges for outpatient setting,$343.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$563.98 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$352.49 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$528.74 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$683.20 ,80% of total billed charges for outpatient setting,$329.13 ,$683.20 ,$337.50
Outpatient Medical Services,EMERGENCY ROOM,99285,ER LEVEL 5,450,$867.00 ,$693.60 ,80% of billed charges for outpatient setting,$348.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$576.56 ,135% BCBS fee schedule for outpatient setting,$576.56 ,135% BCBS fee schedule for outpatient setting,$576.56 ,135% BCBS fee schedule for outpatient setting,$506.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$476.85 ,55% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$693.60 ,80% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$472.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$472.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$472.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$348.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$348.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$506.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$693.60 ,80% of total billed charges for outpatient setting,$506.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.25 ,75% of total billed charges for outpatient setting,$693.60 ,80% of total billed charges for outpatient setting,$693.60 ,80% of total billed charges for outpatient setting,$348.88 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$810.06 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$506.29 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$759.43 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$693.60 ,80% of total billed charges for outpatient setting,$348.88 ,$810.06 ,$337.50
Outpatient Medical Services,EMERGENCY ROOM,99291,ER CRITICAL CARE 1ST 30-74 MIN,450,"$1,815.00 ","$1,452.00 ",80% of billed charges for outpatient setting,$730.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,225.38 ",135% BCBS fee schedule for outpatient setting,"$1,225.38 ",135% BCBS fee schedule for outpatient setting,"$1,225.38 ",135% BCBS fee schedule for outpatient setting,$709.15 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$900.00 ,55% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,452.00 ",80% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,$662.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$662.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$662.14 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$730.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$730.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$709.15 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,452.00 ",80% of total billed charges for outpatient setting,$709.15 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,361.25 ",75% of total billed charges for outpatient setting,"$1,452.00 ",80% of total billed charges for outpatient setting,"$1,452.00 ",80% of total billed charges for outpatient setting,$730.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,134.63 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$709.15 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,063.72 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,452.00 ",80% of total billed charges for outpatient setting,$662.14 ,"$1,452.00 ",$337.50
Outpatient Medical Services,EMERGENCY ROOM,99292,ER CRITICAL CARE EA HOUR AFTER,450,"$1,248.00 ",$998.40 ,80% of billed charges for outpatient setting,$502.20 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$842.52 ,135% BCBS fee schedule for outpatient setting,$842.52 ,135% BCBS fee schedule for outpatient setting,$842.52 ,135% BCBS fee schedule for outpatient setting,$624.00 ,Not separately reimbursable per CMS guidelines,$686.40 ,55% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$998.40 ,80% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,$936.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$502.20 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$502.20 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$998.40 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$936.00 ,75% of total billed charges for outpatient setting,$998.40 ,80% of total billed charges for outpatient setting,$998.40 ,80% of total billed charges for outpatient setting,$502.20 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$998.40 ,80% of total billed charges for outpatient setting,$502.20 ,$998.40 ,$337.50
Outpatient Medical Services,LAB,80048,BASIC METABOLIC,301,$60.00 ,$48.00 ,80% of billed charges for outpatient setting,$8.46 ,100% LA Medicaid fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$4.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,55% of total billed charges for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$11.00 ,130% Coventry fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total 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,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% LA Medicaid fee schedule for outpatient setting,$8.46 ,100% LA Medicaid fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$8.46 ,100% UHC fee schedule for outpatient setting,$8.46 ,100% LA Medicaid fee schedule for outpatient setting,$13.53 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.46 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.69 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$4.23 ,$48.00 ,$225.75
Outpatient Medical Services,LAB,80050,GHP TSH,301,$99.00 ,$79.20 ,80% of billed charges for outpatient setting,$45.73 ,100% LA Medicaid fee schedule for outpatient setting,$55.53 ,135% BCBS fee schedule for outpatient setting,$55.53 ,135% BCBS fee schedule for outpatient setting,$55.53 ,135% BCBS fee schedule for outpatient setting,$49.50 ,Not separately reimbursable per CMS guidelines,$54.45 ,55% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$45.73 ,100% LA Medicaid fee schedule for outpatient setting,$45.73 ,100% LA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$79.20 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$74.25 ,75% of total billed charges for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$47.28 ,100% UHC fee schedule for outpatient setting,$45.73 ,100% LA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$79.20 ,80% of total billed charges for outpatient setting,$45.73 ,$79.20 ,$225.75
Outpatient Medical Services,LAB,80053,COMPREHENSIVE METABOLIC PANEL,301,$73.50 ,$58.80 ,80% of billed charges for outpatient setting,$10.56 ,100% LA Medicaid fee schedule for outpatient setting,$37.33 ,135% BCBS fee schedule for outpatient setting,$37.33 ,135% BCBS fee schedule for outpatient setting,$37.33 ,135% BCBS fee schedule for outpatient setting,$5.28 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.43 ,55% of total billed charges for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$13.73 ,130% Coventry fee schedule for outpatient setting,$58.80 ,80% of total billed charges for outpatient setting,$55.13 ,75% of total billed charges for outpatient setting,$55.13 ,75% of total billed charges for outpatient setting,$55.13 ,75% of total billed charges for outpatient setting,$55.13 ,75% of total 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,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% LA Medicaid fee schedule for outpatient setting,$10.56 ,100% LA Medicaid fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.80 ,80% of total billed charges for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.13 ,75% of total billed charges for outpatient setting,$58.80 ,80% of total billed charges for outpatient setting,$10.56 ,100% UHC fee schedule for outpatient setting,$10.56 ,100% LA Medicaid fee schedule for outpatient setting,$16.89 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$10.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.84 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$58.80 ,80% of total billed charges for outpatient setting,$5.28 ,$58.80 ,$225.75
Outpatient Medical Services,LAB,80061,LIPID SURVEY,301,$67.00 ,$53.60 ,80% of billed charges for outpatient setting,$13.39 ,100% LA Medicaid fee schedule for outpatient setting,$42.17 ,135% BCBS fee schedule for outpatient setting,$42.17 ,135% BCBS fee schedule for outpatient setting,$42.17 ,135% BCBS fee schedule for outpatient setting,$6.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.85 ,55% of total billed charges for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$17.41 ,130% Coventry fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total 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,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% LA Medicaid fee schedule for outpatient setting,$13.39 ,100% LA Medicaid fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$13.39 ,100% UHC fee schedule for outpatient setting,$13.39 ,100% LA Medicaid fee schedule for outpatient setting,$21.42 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$6.69 ,$53.60 ,$225.75
Outpatient Medical Services,LAB,80069,RENAL PANEL,301,$67.00 ,$53.60 ,80% of billed charges for outpatient setting,$8.68 ,100% LA Medicaid fee schedule for outpatient setting,$30.66 ,135% BCBS fee schedule for outpatient setting,$30.66 ,135% BCBS fee schedule for outpatient setting,$30.66 ,135% BCBS fee schedule for outpatient setting,$4.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.85 ,55% of total billed charges for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$11.28 ,130% Coventry fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.68 ,100% LA Medicaid fee schedule for outpatient setting,$8.68 ,100% LA Medicaid fee schedule for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.25 ,75% of total billed charges for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$8.68 ,100% UHC fee schedule for outpatient setting,$8.68 ,100% LA Medicaid fee schedule for outpatient setting,$13.88 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.02 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$53.60 ,80% of total billed charges for outpatient setting,$4.34 ,$53.60 ,$225.75
Outpatient Medical Services,LAB,80074,HEPATITIS SCREEN W/ REFLEX,301,$268.00 ,$214.40 ,80% of billed charges for outpatient setting,$47.63 ,100% LA Medicaid fee schedule for outpatient setting,$168.17 ,135% BCBS fee schedule for outpatient setting,$168.17 ,135% BCBS fee schedule for outpatient setting,$168.17 ,135% BCBS fee schedule for outpatient setting,$23.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$147.40 ,55% of total billed charges for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$61.92 ,130% Coventry fee schedule for outpatient setting,$214.40 ,80% of total billed charges for outpatient setting,$201.00 ,75% of total billed charges for outpatient setting,$201.00 ,75% of total billed charges for outpatient setting,$201.00 ,75% of total billed charges for outpatient setting,$201.00 ,75% of total 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,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.63 ,100% LA Medicaid fee schedule for outpatient setting,$47.63 ,100% LA Medicaid fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$214.40 ,80% of total billed charges for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.00 ,75% of total billed charges for outpatient setting,$214.40 ,80% of total billed charges for outpatient setting,$47.63 ,100% UHC fee schedule for outpatient setting,$47.63 ,100% LA Medicaid fee schedule for outpatient setting,$76.20 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$47.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.44 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$214.40 ,80% of total billed charges for outpatient setting,$23.81 ,$214.40 ,$225.75
Outpatient Medical Services,LAB,80076,LIVER FUNCTION STUDY,301,$60.00 ,$48.00 ,80% of billed charges for outpatient setting,$8.17 ,100% LA Medicaid fee schedule for outpatient setting,$28.85 ,135% BCBS fee schedule for outpatient setting,$28.85 ,135% BCBS fee schedule for outpatient setting,$28.85 ,135% BCBS fee schedule for outpatient setting,$4.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,55% of total billed charges for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$10.62 ,130% Coventry fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total 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,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% LA Medicaid fee schedule for outpatient setting,$8.17 ,100% LA Medicaid fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$8.17 ,100% UHC fee schedule for outpatient setting,$8.17 ,100% LA Medicaid fee schedule for outpatient setting,$13.07 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.25 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$4.08 ,$48.00 ,$225.75
Outpatient Medical Services,LAB,81000,URINALISYS,300,$15.00 ,$12.00 ,80% of billed charges for outpatient setting,$4.02 ,100% LA Medicaid fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$2.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,55% of total billed charges for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$5.23 ,130% Coventry fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.02 ,100% LA Medicaid fee schedule for outpatient setting,$4.02 ,100% LA Medicaid fee schedule for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$4.02 ,100% UHC fee schedule for outpatient setting,$4.02 ,100% LA Medicaid fee schedule for outpatient setting,$6.43 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$4.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.02 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$2.00 ,$12.00 ,$225.00
Outpatient Medical Services,LAB,81001,URINALYSIS W MICRO,300,$35.00 ,$28.00 ,80% of billed charges for outpatient setting,$3.17 ,100% LA Medicaid fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$11.19 ,135% BCBS fee schedule for outpatient setting,$1.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.25 ,55% of total billed charges for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$4.12 ,130% Coventry fee schedule for outpatient setting,$28.00 ,80% of total billed charges for outpatient setting,$26.25 ,75% of total billed charges for outpatient setting,$26.25 ,75% of total billed charges for outpatient setting,$26.25 ,75% of total billed charges for outpatient setting,$26.25 ,75% of total 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,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% LA Medicaid fee schedule for outpatient setting,$3.17 ,100% LA Medicaid fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.00 ,80% of total billed charges for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.25 ,75% of total billed charges for outpatient setting,$28.00 ,80% of total billed charges for outpatient setting,$3.17 ,100% UHC fee schedule for outpatient setting,$3.17 ,100% LA Medicaid fee schedule for outpatient setting,$5.07 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$3.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.75 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$28.00 ,80% of total billed charges for outpatient setting,$1.58 ,$28.00 ,$225.00
Outpatient Medical Services,LAB,81002,URINE DIP,300,$15.00 ,$12.00 ,80% of billed charges for outpatient setting,$3.48 ,100% LA Medicaid fee schedule for outpatient setting,$9.02 ,135% BCBS fee schedule for outpatient setting,$9.02 ,135% BCBS fee schedule for outpatient setting,$9.02 ,135% BCBS fee schedule for outpatient setting,$1.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,55% of total billed charges for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$4.52 ,130% Coventry fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.48 ,100% LA Medicaid fee schedule for outpatient setting,$3.48 ,100% LA Medicaid fee schedule for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$3.48 ,100% UHC fee schedule for outpatient setting,$3.48 ,100% LA Medicaid fee schedule for outpatient setting,$5.56 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$3.48 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.22 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$1.74 ,$12.00 ,$225.00
Outpatient Medical Services,LAB,81003,URINALYSIS W/ AUTOMATED,300,$15.00 ,$12.00 ,80% of billed charges for outpatient setting,$2.25 ,100% LA Medicaid fee schedule for outpatient setting,$7.94 ,135% BCBS fee schedule for outpatient setting,$7.94 ,135% BCBS fee schedule for outpatient setting,$7.94 ,135% BCBS fee schedule for outpatient setting,$1.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.25 ,55% of total billed charges for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$2.93 ,130% Coventry fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$11.25 ,75% of total 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,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% LA Medicaid fee schedule for outpatient setting,$2.25 ,100% LA Medicaid fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.25 ,75% of total billed charges for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$2.25 ,100% UHC fee schedule for outpatient setting,$2.25 ,100% LA Medicaid fee schedule for outpatient setting,$3.60 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$12.00 ,80% of total billed charges for outpatient setting,$1.12 ,$12.00 ,$225.00
Outpatient Medical Services,LAB,81025,URINE PREGNANCY,301,$36.00 ,$28.80 ,80% of billed charges for outpatient setting,$8.61 ,100% LA Medicaid fee schedule for outpatient setting,$22.34 ,135% BCBS fee schedule for outpatient setting,$22.34 ,135% BCBS fee schedule for outpatient setting,$22.34 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.80 ,55% of total billed charges for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$11.19 ,130% Coventry fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$8.61 ,100% UHC fee schedule for outpatient setting,$8.61 ,100% LA Medicaid fee schedule for outpatient setting,$13.77 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.91 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$4.30 ,$28.80 ,$225.75
Outpatient Medical Services,LAB,82180,VITAMIN C,300,$91.00 ,$72.80 ,80% of billed charges for outpatient setting,$9.89 ,100% LA Medicaid fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$29.90 ,135% BCBS fee schedule for outpatient setting,$4.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.05 ,55% of total billed charges for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$12.86 ,130% Coventry fee schedule for outpatient setting,$72.80 ,80% of total billed charges for outpatient setting,$68.25 ,75% of total billed charges for outpatient setting,$68.25 ,75% of total billed charges for outpatient setting,$68.25 ,75% of total billed charges for outpatient setting,$68.25 ,75% of total billed charges for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.89 ,100% LA Medicaid fee schedule for outpatient setting,$9.89 ,100% LA Medicaid fee schedule for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.80 ,80% of total billed charges for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.25 ,75% of total billed charges for outpatient setting,$72.80 ,80% of total billed charges for outpatient setting,$9.89 ,100% UHC fee schedule for outpatient setting,$9.89 ,100% LA Medicaid fee schedule for outpatient setting,$15.82 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$9.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.83 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.80 ,80% of total billed charges for outpatient setting,$4.94 ,$72.80 ,$225.00
Outpatient Medical Services,LAB,82306,VITAMIN D 25 OH,301,$167.00 ,$133.60 ,80% of billed charges for outpatient setting,$29.60 ,100% LA Medicaid fee schedule for outpatient setting,$104.53 ,135% BCBS fee schedule for outpatient setting,$104.53 ,135% BCBS fee schedule for outpatient setting,$104.53 ,135% BCBS fee schedule for outpatient setting,$14.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$91.85 ,55% of total billed charges for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$38.48 ,130% Coventry fee schedule for outpatient setting,$133.60 ,80% of total billed charges for outpatient setting,$125.25 ,75% of total billed charges for outpatient setting,$125.25 ,75% of total billed charges for outpatient setting,$125.25 ,75% of total billed charges for outpatient setting,$125.25 ,75% of total 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,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% LA Medicaid fee schedule for outpatient setting,$29.60 ,100% LA Medicaid fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.60 ,80% of total billed charges for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.25 ,75% of total billed charges for outpatient setting,$133.60 ,80% of total billed charges for outpatient setting,$29.60 ,100% UHC fee schedule for outpatient setting,$29.60 ,100% LA Medicaid fee schedule for outpatient setting,$47.36 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.40 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$133.60 ,80% of total billed charges for outpatient setting,$14.80 ,$133.60 ,$225.75
Outpatient Medical Services,LAB,82310,CALCIUM TOTAL,301,$29.00 ,$23.20 ,80% of billed charges for outpatient setting,$5.16 ,100% LA Medicaid fee schedule for outpatient setting,$18.20 ,135% BCBS fee schedule for outpatient setting,$18.20 ,135% BCBS fee schedule for outpatient setting,$18.20 ,135% BCBS fee schedule for outpatient setting,$2.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.95 ,55% of total billed charges for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$6.71 ,130% Coventry fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.16 ,100% LA Medicaid fee schedule for outpatient setting,$5.16 ,100% LA Medicaid fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.16 ,100% UHC fee schedule for outpatient setting,$5.16 ,100% LA Medicaid fee schedule for outpatient setting,$8.25 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.74 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$2.58 ,$23.20 ,$225.75
Outpatient Medical Services,LAB,82550,CPK TOTAL,301,$37.00 ,$29.60 ,80% of billed charges for outpatient setting,$6.51 ,100% LA Medicaid fee schedule for outpatient setting,$22.99 ,135% BCBS fee schedule for outpatient setting,$22.99 ,135% BCBS fee schedule for outpatient setting,$22.99 ,135% BCBS fee schedule for outpatient setting,$3.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.35 ,55% of total billed charges for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$8.46 ,130% Coventry fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$27.75 ,75% of total 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,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% LA Medicaid fee schedule for outpatient setting,$6.51 ,100% LA Medicaid fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.75 ,75% of total billed charges for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$6.51 ,100% UHC fee schedule for outpatient setting,$6.51 ,100% LA Medicaid fee schedule for outpatient setting,$10.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.76 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$29.60 ,80% of total billed charges for outpatient setting,$3.25 ,$29.60 ,$225.75
Outpatient Medical Services,LAB,82565,CREATININE-SERUM,301,$29.00 ,$23.20 ,80% of billed charges for outpatient setting,$5.12 ,100% LA Medicaid fee schedule for outpatient setting,$18.09 ,135% BCBS fee schedule for outpatient setting,$18.09 ,135% BCBS fee schedule for outpatient setting,$18.09 ,135% BCBS fee schedule for outpatient setting,$2.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.95 ,55% of total billed charges for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$6.66 ,130% Coventry fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total 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,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.12 ,100% LA Medicaid fee schedule for outpatient setting,$5.12 ,100% LA Medicaid fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.12 ,100% UHC fee schedule for outpatient setting,$5.12 ,100% LA Medicaid fee schedule for outpatient setting,$8.19 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.12 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.68 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$2.56 ,$23.20 ,$225.75
Outpatient Medical Services,LAB,82607,B12,301,$85.00 ,$68.00 ,80% of billed charges for outpatient setting,$15.08 ,100% LA Medicaid fee schedule for outpatient setting,$53.23 ,135% BCBS fee schedule for outpatient setting,$53.23 ,135% BCBS fee schedule for outpatient setting,$53.23 ,135% BCBS fee schedule for outpatient setting,$7.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.75 ,55% of total billed charges for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$19.60 ,130% Coventry fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total 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,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% LA Medicaid fee schedule for outpatient setting,$15.08 ,100% LA Medicaid fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$15.08 ,100% UHC fee schedule for outpatient setting,$15.08 ,100% LA Medicaid fee schedule for outpatient setting,$24.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$15.08 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.62 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$7.54 ,$68.00 ,$225.75
Outpatient Medical Services,LAB,82670,ESTRADIOL,301,$157.00 ,$125.60 ,80% of billed charges for outpatient setting,$27.94 ,100% LA Medicaid fee schedule for outpatient setting,$98.67 ,135% BCBS fee schedule for outpatient setting,$98.67 ,135% BCBS fee schedule for outpatient setting,$98.67 ,135% BCBS fee schedule for outpatient setting,$13.97 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.35 ,55% of total billed charges for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$36.32 ,130% Coventry fee schedule for outpatient setting,$125.60 ,80% of total billed charges for outpatient setting,$117.75 ,75% of total billed charges for outpatient setting,$117.75 ,75% of total billed charges for outpatient setting,$117.75 ,75% of total billed charges for outpatient setting,$117.75 ,75% of total billed charges for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.94 ,100% LA Medicaid fee schedule for outpatient setting,$27.94 ,100% LA Medicaid fee schedule for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.60 ,80% of total billed charges for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$117.75 ,75% of total billed charges for outpatient setting,$125.60 ,80% of total billed charges for outpatient setting,$27.94 ,100% UHC fee schedule for outpatient setting,$27.94 ,100% LA Medicaid fee schedule for outpatient setting,$44.70 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$27.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.91 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$125.60 ,80% of total billed charges for outpatient setting,$13.97 ,$125.60 ,$225.75
Outpatient Medical Services,LAB,82728,FERRITIN,301,$77.00 ,$61.60 ,80% of billed charges for outpatient setting,$13.63 ,100% LA Medicaid fee schedule for outpatient setting,$48.09 ,135% BCBS fee schedule for outpatient setting,$48.09 ,135% BCBS fee schedule for outpatient setting,$48.09 ,135% BCBS fee schedule for outpatient setting,$6.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.35 ,55% of total billed charges for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$17.72 ,130% Coventry fee schedule for outpatient setting,$61.60 ,80% of total billed charges for outpatient setting,$57.75 ,75% of total billed charges for outpatient setting,$57.75 ,75% of total billed charges for outpatient setting,$57.75 ,75% of total billed charges for outpatient setting,$57.75 ,75% of total 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,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,100% LA Medicaid fee schedule for outpatient setting,$13.63 ,100% LA Medicaid fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.60 ,80% of total billed charges for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.75 ,75% of total billed charges for outpatient setting,$61.60 ,80% of total billed charges for outpatient setting,$13.63 ,100% UHC fee schedule for outpatient setting,$13.63 ,100% LA Medicaid fee schedule for outpatient setting,$21.80 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.63 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.44 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$61.60 ,80% of total billed charges for outpatient setting,$6.81 ,$61.60 ,$225.75
Outpatient Medical Services,LAB,82746,FOLATE,301,$83.00 ,$66.40 ,80% of billed charges for outpatient setting,$14.70 ,100% LA Medicaid fee schedule for outpatient setting,$51.91 ,135% BCBS fee schedule for outpatient setting,$51.91 ,135% BCBS fee schedule for outpatient setting,$51.91 ,135% BCBS fee schedule for outpatient setting,$7.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.65 ,55% of total billed charges for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$19.11 ,130% Coventry fee schedule for outpatient setting,$66.40 ,80% of total billed charges for outpatient setting,$62.25 ,75% of total billed charges for outpatient setting,$62.25 ,75% of total billed charges for outpatient setting,$62.25 ,75% of total billed charges for outpatient setting,$62.25 ,75% of total 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,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.70 ,100% LA Medicaid fee schedule for outpatient setting,$14.70 ,100% LA Medicaid fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.40 ,80% of total billed charges for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$62.25 ,75% of total billed charges for outpatient setting,$66.40 ,80% of total billed charges for outpatient setting,$14.70 ,100% UHC fee schedule for outpatient setting,$14.70 ,100% LA Medicaid fee schedule for outpatient setting,$23.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$14.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.05 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$66.40 ,80% of total billed charges for outpatient setting,$7.35 ,$66.40 ,$225.75
Outpatient Medical Services,LAB,82950,GESTATIONAL DIABETES SCREEN,301,$80.00 ,$64.00 ,80% of billed charges for outpatient setting,$4.75 ,100% LA Medicaid fee schedule for outpatient setting,$16.78 ,135% BCBS fee schedule for outpatient setting,$16.78 ,135% BCBS fee schedule for outpatient setting,$16.78 ,135% BCBS fee schedule for outpatient setting,$2.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.00 ,55% of total billed charges for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$6.18 ,130% Coventry fee schedule for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.75 ,100% LA Medicaid fee schedule for outpatient setting,$4.75 ,100% LA Medicaid fee schedule for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.00 ,75% of total billed charges for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$4.75 ,100% UHC fee schedule for outpatient setting,$4.75 ,100% LA Medicaid fee schedule for outpatient setting,$7.60 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$4.75 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.12 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$64.00 ,80% of total billed charges for outpatient setting,$2.37 ,$64.00 ,$225.75
Outpatient Medical Services,LAB,83540,IRON,301,$37.50 ,$30.00 ,80% of billed charges for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$18.94 ,135% BCBS fee schedule for outpatient setting,$18.94 ,135% BCBS fee schedule for outpatient setting,$18.94 ,135% BCBS fee schedule for outpatient setting,$3.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.63 ,55% of total billed charges for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$30.00 ,80% of total billed charges for outpatient setting,$28.13 ,75% of total billed charges for outpatient setting,$28.13 ,75% of total billed charges for outpatient setting,$28.13 ,75% of total billed charges for outpatient setting,$28.13 ,75% of total 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,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.00 ,80% of total billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.13 ,75% of total billed charges for outpatient setting,$30.00 ,80% of total billed charges for outpatient setting,$6.47 ,100% UHC fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$10.35 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.70 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$30.00 ,80% of total billed charges for outpatient setting,$3.23 ,$30.00 ,$225.75
Outpatient Medical Services,LAB,83615,LDH,301,$34.00 ,$27.20 ,80% of billed charges for outpatient setting,$6.04 ,100% LA Medicaid fee schedule for outpatient setting,$21.33 ,135% BCBS fee schedule for outpatient setting,$21.33 ,135% BCBS fee schedule for outpatient setting,$21.33 ,135% BCBS fee schedule for outpatient setting,$3.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.70 ,55% of total billed charges for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$7.85 ,130% Coventry fee schedule for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.04 ,100% LA Medicaid fee schedule for outpatient setting,$6.04 ,100% LA Medicaid fee schedule for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.50 ,75% of total billed charges for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$6.04 ,100% UHC fee schedule for outpatient setting,$6.04 ,100% LA Medicaid fee schedule for outpatient setting,$9.66 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.04 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.06 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$27.20 ,80% of total billed charges for outpatient setting,$3.02 ,$27.20 ,$225.75
Outpatient Medical Services,LAB,83655,LEAD BLOOD (PEDIATRIC),301,$110.00 ,$88.00 ,80% of billed charges for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$6.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.50 ,55% of total billed charges for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total 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,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$12.11 ,100% UHC fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$19.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.16 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$6.05 ,$88.00 ,$225.75
Outpatient Medical Services,LAB,83655,LEAD BLOOD (ADULT),301,$110.00 ,$88.00 ,80% of billed charges for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$42.74 ,135% BCBS fee schedule for outpatient setting,$6.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.50 ,55% of total billed charges for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$15.74 ,130% Coventry fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$82.50 ,75% of total 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,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.50 ,75% of total billed charges for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$12.11 ,100% UHC fee schedule for outpatient setting,$12.11 ,100% LA Medicaid fee schedule for outpatient setting,$19.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$12.11 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.16 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$88.00 ,80% of total billed charges for outpatient setting,$6.05 ,$88.00 ,$225.75
Outpatient Medical Services,LAB,83690,LIPASE,301,$39.00 ,$31.20 ,80% of billed charges for outpatient setting,$6.89 ,100% LA Medicaid fee schedule for outpatient setting,$24.31 ,135% BCBS fee schedule for outpatient setting,$24.31 ,135% BCBS fee schedule for outpatient setting,$24.31 ,135% BCBS fee schedule for outpatient setting,$3.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.45 ,55% of total billed charges for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$8.96 ,130% Coventry fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total 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,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,100% LA Medicaid fee schedule for outpatient setting,$6.89 ,100% LA Medicaid fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$6.89 ,100% UHC fee schedule for outpatient setting,$6.89 ,100% LA Medicaid fee schedule for outpatient setting,$11.02 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.33 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$3.44 ,$31.20 ,$225.75
Outpatient Medical Services,LAB,83718,HDL,301,$46.00 ,$36.80 ,80% of billed charges for outpatient setting,$8.19 ,100% LA Medicaid fee schedule for outpatient setting,$28.90 ,135% BCBS fee schedule for outpatient setting,$28.90 ,135% BCBS fee schedule for outpatient setting,$28.90 ,135% BCBS fee schedule for outpatient setting,$4.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.30 ,55% of total billed charges for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$10.65 ,130% Coventry fee schedule for outpatient setting,$36.80 ,80% of total billed charges for outpatient setting,$34.50 ,75% of total billed charges for outpatient setting,$34.50 ,75% of total billed charges for outpatient setting,$34.50 ,75% of total billed charges for outpatient setting,$34.50 ,75% of total billed charges for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.19 ,100% LA Medicaid fee schedule for outpatient setting,$8.19 ,100% LA Medicaid fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.80 ,80% of total billed charges for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.50 ,75% of total billed charges for outpatient setting,$36.80 ,80% of total billed charges for outpatient setting,$8.19 ,100% UHC fee schedule for outpatient setting,$8.19 ,100% LA Medicaid fee schedule for outpatient setting,$13.10 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.28 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$36.80 ,80% of total billed charges for outpatient setting,$4.09 ,$36.80 ,$225.75
Outpatient Medical Services,LAB,83735,MAGNESIUM,301,$38.00 ,$30.40 ,80% of billed charges for outpatient setting,$6.70 ,100% LA Medicaid fee schedule for outpatient setting,$23.65 ,135% BCBS fee schedule for outpatient setting,$23.65 ,135% BCBS fee schedule for outpatient setting,$23.65 ,135% BCBS fee schedule for outpatient setting,$3.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.90 ,55% of total billed charges for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$8.71 ,130% Coventry fee schedule for outpatient setting,$30.40 ,80% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$28.50 ,75% of total 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,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% LA Medicaid fee schedule for outpatient setting,$6.70 ,100% LA Medicaid fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.40 ,80% of total billed charges for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.50 ,75% of total billed charges for outpatient setting,$30.40 ,80% of total billed charges for outpatient setting,$6.70 ,100% UHC fee schedule for outpatient setting,$6.70 ,100% LA Medicaid fee schedule for outpatient setting,$10.72 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.70 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.05 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$30.40 ,80% of total billed charges for outpatient setting,$3.35 ,$30.40 ,$225.75
Outpatient Medical Services,LAB,84132,POTASSIUM-SERUM,301,$26.00 ,$20.80 ,80% of billed charges for outpatient setting,$4.76 ,100% LA Medicaid fee schedule for outpatient setting,$16.21 ,135% BCBS fee schedule for outpatient setting,$16.21 ,135% BCBS fee schedule for outpatient setting,$16.21 ,135% BCBS fee schedule for outpatient setting,$2.38 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.30 ,55% of total billed charges for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$6.19 ,130% Coventry fee schedule for outpatient setting,$20.80 ,80% of total billed charges for outpatient setting,$19.50 ,75% of total billed charges for outpatient setting,$19.50 ,75% of total billed charges for outpatient setting,$19.50 ,75% of total billed charges for outpatient setting,$19.50 ,75% of total 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,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.76 ,100% LA Medicaid fee schedule for outpatient setting,$4.76 ,100% LA Medicaid fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.80 ,80% of total billed charges for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.50 ,75% of total billed charges for outpatient setting,$20.80 ,80% of total billed charges for outpatient setting,$4.76 ,100% UHC fee schedule for outpatient setting,$4.76 ,100% LA Medicaid fee schedule for outpatient setting,$7.61 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$4.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.14 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$20.80 ,80% of total billed charges for outpatient setting,$2.38 ,$20.80 ,$225.75
Outpatient Medical Services,LAB,84144,PROGESTERONE,301,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.86 ,100% LA Medicaid fee schedule for outpatient setting,$73.67 ,135% BCBS fee schedule for outpatient setting,$73.67 ,135% BCBS fee schedule for outpatient setting,$73.67 ,135% BCBS fee schedule for outpatient setting,$10.43 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$27.12 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.86 ,100% LA Medicaid fee schedule for outpatient setting,$20.86 ,100% LA Medicaid fee schedule for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.86 ,100% UHC fee schedule for outpatient setting,$20.86 ,100% LA Medicaid fee schedule for outpatient setting,$33.37 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.29 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.43 ,$93.60 ,$225.75
Outpatient Medical Services,LAB,84153,PSA DIAGNOSTIC,301,$104.00 ,$83.20 ,80% of billed charges for outpatient setting,$18.39 ,100% LA Medicaid fee schedule for outpatient setting,$64.95 ,135% BCBS fee schedule for outpatient setting,$64.95 ,135% BCBS fee schedule for outpatient setting,$64.95 ,135% BCBS fee schedule for outpatient setting,$9.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.20 ,55% of total billed charges for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$23.91 ,130% Coventry fee schedule for outpatient setting,$83.20 ,80% of total billed charges for outpatient setting,$78.00 ,75% of total billed charges for outpatient setting,$78.00 ,75% of total billed charges for outpatient setting,$78.00 ,75% of total billed charges for outpatient setting,$78.00 ,75% of total billed charges for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.39 ,100% LA Medicaid fee schedule for outpatient setting,$18.39 ,100% LA Medicaid fee schedule for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$83.20 ,80% of total billed charges for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.00 ,75% of total billed charges for outpatient setting,$83.20 ,80% of total billed charges for outpatient setting,$18.39 ,100% UHC fee schedule for outpatient setting,$18.39 ,100% LA Medicaid fee schedule for outpatient setting,$29.42 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$18.39 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.58 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$83.20 ,80% of total billed charges for outpatient setting,$9.19 ,$83.20 ,$225.75
Outpatient Medical Services,LAB,84155,TOTAL PROTEIN,301,$23.00 ,$18.40 ,80% of billed charges for outpatient setting,$3.67 ,100% LA Medicaid fee schedule for outpatient setting,$12.93 ,135% BCBS fee schedule for outpatient setting,$12.93 ,135% BCBS fee schedule for outpatient setting,$12.93 ,135% BCBS fee schedule for outpatient setting,$1.83 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.65 ,55% of total billed charges for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$4.77 ,130% Coventry fee schedule for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$17.25 ,75% of total 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,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.67 ,100% LA Medicaid fee schedule for outpatient setting,$3.67 ,100% LA Medicaid fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.25 ,75% of total billed charges for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$3.67 ,100% UHC fee schedule for outpatient setting,$3.67 ,100% LA Medicaid fee schedule for outpatient setting,$5.87 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$3.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.50 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$18.40 ,80% of total billed charges for outpatient setting,$1.83 ,$18.40 ,$225.75
Outpatient Medical Services,LAB,84402,TESTOSTERONE FREE & TOTAL,301,$76.50 ,$61.20 ,80% of billed charges for outpatient setting,$25.47 ,100% LA Medicaid fee schedule for outpatient setting,$89.90 ,135% BCBS fee schedule for outpatient setting,$89.90 ,135% BCBS fee schedule for outpatient setting,$89.90 ,135% BCBS fee schedule for outpatient setting,$12.73 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.08 ,55% of total billed charges for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$33.11 ,130% Coventry fee schedule for outpatient setting,$61.20 ,80% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.47 ,100% LA Medicaid fee schedule for outpatient setting,$25.47 ,100% LA Medicaid fee schedule for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$61.20 ,80% of total billed charges for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.38 ,75% of total billed charges for outpatient setting,$61.20 ,80% of total billed charges for outpatient setting,$25.47 ,100% UHC fee schedule for outpatient setting,$25.47 ,100% LA Medicaid fee schedule for outpatient setting,$40.75 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$25.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.20 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$61.20 ,80% of total billed charges for outpatient setting,$12.73 ,$89.90 ,$225.75
Outpatient Medical Services,LAB,84439,T-4 FREE,301,$62.00 ,$49.60 ,80% of billed charges for outpatient setting,$9.02 ,100% LA Medicaid fee schedule for outpatient setting,$31.83 ,135% BCBS fee schedule for outpatient setting,$31.83 ,135% BCBS fee schedule for outpatient setting,$31.83 ,135% BCBS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.10 ,55% of total billed charges for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$11.73 ,130% Coventry fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$46.50 ,75% of total 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,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% LA Medicaid fee schedule for outpatient setting,$9.02 ,100% LA Medicaid fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.50 ,75% of total billed charges for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$9.02 ,100% UHC fee schedule for outpatient setting,$9.02 ,100% LA Medicaid fee schedule for outpatient setting,$14.43 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$9.02 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.53 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$49.60 ,80% of total billed charges for outpatient setting,$4.51 ,$49.60 ,$225.75
Outpatient Medical Services,LAB,84443,TSH,301,$95.00 ,$76.00 ,80% of billed charges for outpatient setting,$16.80 ,100% LA Medicaid fee schedule for outpatient setting,$59.32 ,135% BCBS fee schedule for outpatient setting,$59.32 ,135% BCBS fee schedule for outpatient setting,$59.32 ,135% BCBS fee schedule for outpatient setting,$8.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.25 ,55% of total billed charges for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$21.84 ,130% Coventry fee schedule for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$71.25 ,75% of total 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,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% LA Medicaid fee schedule for outpatient setting,$16.80 ,100% LA Medicaid fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.25 ,75% of total billed charges for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$16.80 ,100% UHC fee schedule for outpatient setting,$16.80 ,100% LA Medicaid fee schedule for outpatient setting,$26.88 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.20 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$76.00 ,80% of total billed charges for outpatient setting,$8.40 ,$76.00 ,$225.75
Outpatient Medical Services,LAB,84446,VITAMIN E,301,$81.00 ,$64.80 ,80% of billed charges for outpatient setting,$14.18 ,100% LA Medicaid fee schedule for outpatient setting,$50.07 ,135% BCBS fee schedule for outpatient setting,$50.07 ,135% BCBS fee schedule for outpatient setting,$50.07 ,135% BCBS fee schedule for outpatient setting,$7.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$44.55 ,55% of total billed charges for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$18.43 ,130% Coventry fee schedule for outpatient setting,$64.80 ,80% of total billed charges for outpatient setting,$60.75 ,75% of total billed charges for outpatient setting,$60.75 ,75% of total billed charges for outpatient setting,$60.75 ,75% of total billed charges for outpatient setting,$60.75 ,75% of total billed charges for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.18 ,100% LA Medicaid fee schedule for outpatient setting,$14.18 ,100% LA Medicaid fee schedule for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.80 ,80% of total billed charges for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.75 ,75% of total billed charges for outpatient setting,$64.80 ,80% of total billed charges for outpatient setting,$14.18 ,100% UHC fee schedule for outpatient setting,$14.18 ,100% LA Medicaid fee schedule for outpatient setting,$22.68 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$14.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.27 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$64.80 ,80% of total billed charges for outpatient setting,$7.09 ,$64.80 ,$225.75
Outpatient Medical Services,LAB,84478,TRIGLYCERIDES,301,$32.00 ,$25.60 ,80% of billed charges for outpatient setting,$5.74 ,100% LA Medicaid fee schedule for outpatient setting,$20.32 ,135% BCBS fee schedule for outpatient setting,$20.32 ,135% BCBS fee schedule for outpatient setting,$20.32 ,135% BCBS fee schedule for outpatient setting,$2.87 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.60 ,55% of total billed charges for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$7.46 ,130% Coventry fee schedule for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.74 ,100% LA Medicaid fee schedule for outpatient setting,$5.74 ,100% LA Medicaid fee schedule for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.00 ,75% of total billed charges for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$5.74 ,100% UHC fee schedule for outpatient setting,$5.74 ,100% LA Medicaid fee schedule for outpatient setting,$9.18 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.74 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$25.60 ,80% of total billed charges for outpatient setting,$2.87 ,$25.60 ,$225.75
Outpatient Medical Services,LAB,84484,TROPONIN I HS QUANTITATIVE,301,$108.50 ,$86.80 ,80% of billed charges for outpatient setting,$12.47 ,100% LA Medicaid fee schedule for outpatient setting,$34.75 ,135% BCBS fee schedule for outpatient setting,$34.75 ,135% BCBS fee schedule for outpatient setting,$34.75 ,135% BCBS fee schedule for outpatient setting,$6.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.68 ,55% of total billed charges for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$16.21 ,130% Coventry fee schedule for outpatient setting,$86.80 ,80% of total billed charges for outpatient setting,$81.38 ,75% of total billed charges for outpatient setting,$81.38 ,75% of total billed charges for outpatient setting,$81.38 ,75% of total billed charges for outpatient setting,$81.38 ,75% of total 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,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% LA Medicaid fee schedule for outpatient setting,$12.47 ,100% LA Medicaid fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.80 ,80% of total billed charges for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.38 ,75% of total billed charges for outpatient setting,$86.80 ,80% of total billed charges for outpatient setting,$12.47 ,100% UHC fee schedule for outpatient setting,$12.47 ,100% LA Medicaid fee schedule for outpatient setting,$19.95 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$12.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.70 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$86.80 ,80% of total billed charges for outpatient setting,$6.23 ,$86.80 ,$225.75
Outpatient Medical Services,LAB,84540,24 HOUR BUN/CREATININE,301,$40.50 ,$32.40 ,80% of billed charges for outpatient setting,$5.56 ,100% LA Medicaid fee schedule for outpatient setting,$16.43 ,135% BCBS fee schedule for outpatient setting,$16.43 ,135% BCBS fee schedule for outpatient setting,$16.43 ,135% BCBS fee schedule for outpatient setting,$2.78 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.28 ,55% of total billed charges for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$7.23 ,130% Coventry fee schedule for outpatient setting,$32.40 ,80% of total billed charges for outpatient setting,$30.38 ,75% of total billed charges for outpatient setting,$30.38 ,75% of total billed charges for outpatient setting,$30.38 ,75% of total billed charges for outpatient setting,$30.38 ,75% of total billed charges for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.56 ,100% LA Medicaid fee schedule for outpatient setting,$5.56 ,100% LA Medicaid fee schedule for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.40 ,80% of total billed charges for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.38 ,75% of total billed charges for outpatient setting,$32.40 ,80% of total billed charges for outpatient setting,$5.56 ,100% UHC fee schedule for outpatient setting,$5.56 ,100% LA Medicaid fee schedule for outpatient setting,$8.89 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.56 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.33 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$32.40 ,80% of total billed charges for outpatient setting,$2.78 ,$32.40 ,$225.75
Outpatient Medical Services,LAB,84550,URIC ACID BLOOD,301,$25.00 ,$20.00 ,80% of billed charges for outpatient setting,$4.52 ,100% LA Medicaid fee schedule for outpatient setting,$15.96 ,135% BCBS fee schedule for outpatient setting,$15.96 ,135% BCBS fee schedule for outpatient setting,$15.96 ,135% BCBS fee schedule for outpatient setting,$2.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.75 ,55% of total billed charges for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$5.88 ,130% Coventry fee schedule for outpatient setting,$20.00 ,80% of total billed charges for outpatient setting,$18.75 ,75% of total billed charges for outpatient setting,$18.75 ,75% of total billed charges for outpatient setting,$18.75 ,75% of total billed charges for outpatient setting,$18.75 ,75% of total 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,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.52 ,100% LA Medicaid fee schedule for outpatient setting,$4.52 ,100% LA Medicaid fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.00 ,80% of total billed charges for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.75 ,75% of total billed charges for outpatient setting,$20.00 ,80% of total billed charges for outpatient setting,$4.52 ,100% UHC fee schedule for outpatient setting,$4.52 ,100% LA Medicaid fee schedule for outpatient setting,$7.23 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$4.51 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.77 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$20.00 ,80% of total billed charges for outpatient setting,$2.25 ,$20.00 ,$225.75
Outpatient Medical Services,LAB,84702,HCG QUANTITATIVE,301,$85.00 ,$68.00 ,80% of billed charges for outpatient setting,$15.05 ,100% LA Medicaid fee schedule for outpatient setting,$53.14 ,135% BCBS fee schedule for outpatient setting,$53.14 ,135% BCBS fee schedule for outpatient setting,$53.14 ,135% BCBS fee schedule for outpatient setting,$7.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.75 ,55% of total billed charges for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$19.57 ,130% Coventry fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.05 ,100% LA Medicaid fee schedule for outpatient setting,$15.05 ,100% LA Medicaid fee schedule for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.75 ,75% of total billed charges for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$15.05 ,100% UHC fee schedule for outpatient setting,$15.05 ,100% LA Medicaid fee schedule for outpatient setting,$24.08 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$15.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$22.57 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$68.00 ,80% of total billed charges for outpatient setting,$7.52 ,$68.00 ,$225.75
Outpatient Medical Services,LAB,85025,CBC,305,$44.00 ,$35.20 ,80% of billed charges for outpatient setting,$7.77 ,100% LA Medicaid fee schedule for outpatient setting,$27.45 ,135% BCBS fee schedule for outpatient setting,$27.45 ,135% BCBS fee schedule for outpatient setting,$27.45 ,135% BCBS fee schedule for outpatient setting,$3.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.20 ,55% of total billed charges for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$10.10 ,130% Coventry fee schedule for outpatient setting,$35.20 ,80% of total billed charges for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$33.00 ,75% of total 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,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% LA Medicaid fee schedule for outpatient setting,$7.77 ,100% LA Medicaid fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.20 ,80% of total billed charges for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,75% of total billed charges for outpatient setting,$35.20 ,80% of total billed charges for outpatient setting,$7.77 ,100% UHC fee schedule for outpatient setting,$7.77 ,100% LA Medicaid fee schedule for outpatient setting,$12.43 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.65 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$35.20 ,80% of total billed charges for outpatient setting,$3.88 ,$35.20 ,$228.75
Outpatient Medical Services,LAB,85027,CBC W/ MANUAL DIFF,305,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$22.86 ,135% BCBS fee schedule for outpatient setting,$22.86 ,135% BCBS fee schedule for outpatient setting,$22.86 ,135% BCBS fee schedule for outpatient setting,$3.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$8.41 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$6.47 ,100% UHC fee schedule for outpatient setting,$6.47 ,100% LA Medicaid fee schedule for outpatient setting,$10.35 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.47 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.70 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$3.23 ,$39.20 ,$228.75
Outpatient Medical Services,LAB,85610,PT/INR,982,$21.00 ,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$4.29 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$12.60 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$4.29 ,100% CMS RBRVS fee schedule for physician setting,$4.29 ,100% CMS RBRVS fee schedule for physician setting,$4.29 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,,Not separately reimbursable,$4.29 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,$4.29 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$6.01 ,140% CMS RBRVS fee schedule for physician setting,$4.29 ,100% CMS RBRVS fee schedule for physician setting,$6.86 ,160% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,$4.29 ,$12.60 ,$736.50
Outpatient Medical Services,LAB,85651,SED RATE,305,$21.00 ,$16.80 ,80% of billed charges for outpatient setting,$4.27 ,100% LA Medicaid fee schedule for outpatient setting,$12.53 ,135% BCBS fee schedule for outpatient setting,$12.53 ,135% BCBS fee schedule for outpatient setting,$12.53 ,135% BCBS fee schedule for outpatient setting,$2.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.55 ,55% of total billed charges for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$5.55 ,130% Coventry fee schedule for outpatient setting,$16.80 ,80% of total billed charges for outpatient setting,$15.75 ,75% of total billed charges for outpatient setting,$15.75 ,75% of total billed charges for outpatient setting,$15.75 ,75% of total billed charges for outpatient setting,$15.75 ,75% of total 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,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.27 ,100% LA Medicaid fee schedule for outpatient setting,$4.27 ,100% LA Medicaid fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,80% of total billed charges for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.75 ,75% of total billed charges for outpatient setting,$16.80 ,80% of total billed charges for outpatient setting,$4.27 ,100% UHC fee schedule for outpatient setting,$4.27 ,100% LA Medicaid fee schedule for outpatient setting,$6.83 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$4.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.40 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$16.80 ,80% of total billed charges for outpatient setting,$2.13 ,$16.80 ,$228.75
Outpatient Medical Services,LAB,85730,PTT MIXING STUDY,300,$102.00 ,$81.60 ,80% of billed charges for outpatient setting,$6.01 ,100% LA Medicaid fee schedule for outpatient setting,$21.18 ,135% BCBS fee schedule for outpatient setting,$21.18 ,135% BCBS fee schedule for outpatient setting,$21.18 ,135% BCBS fee schedule for outpatient setting,$3.00 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.10 ,55% of total billed charges for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$7.81 ,130% Coventry fee schedule for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$76.50 ,75% of total 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,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% LA Medicaid fee schedule for outpatient setting,$6.01 ,100% LA Medicaid fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$76.50 ,75% of total billed charges for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$6.01 ,100% UHC fee schedule for outpatient setting,$6.01 ,100% LA Medicaid fee schedule for outpatient setting,$9.61 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$6.01 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.01 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$81.60 ,80% of total billed charges for outpatient setting,$3.00 ,$81.60 ,$225.00
Outpatient Medical Services,LAB,86039,ANA TITER,302,$63.00 ,$50.40 ,80% of billed charges for outpatient setting,$11.16 ,100% LA Medicaid fee schedule for outpatient setting,$39.42 ,135% BCBS fee schedule for outpatient setting,$39.42 ,135% BCBS fee schedule for outpatient setting,$39.42 ,135% BCBS fee schedule for outpatient setting,$5.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$34.65 ,55% of total billed charges for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$14.51 ,130% Coventry fee schedule for outpatient setting,$50.40 ,80% of total billed charges for outpatient setting,$47.25 ,75% of total billed charges for outpatient setting,$47.25 ,75% of total billed charges for outpatient setting,$47.25 ,75% of total billed charges for outpatient setting,$47.25 ,75% of total 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,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.16 ,100% LA Medicaid fee schedule for outpatient setting,$11.16 ,100% LA Medicaid fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$50.40 ,80% of total billed charges for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$47.25 ,75% of total billed charges for outpatient setting,$50.40 ,80% of total billed charges for outpatient setting,$11.16 ,100% UHC fee schedule for outpatient setting,$11.16 ,100% LA Medicaid fee schedule for outpatient setting,$17.85 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$11.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.74 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$50.40 ,80% of total billed charges for outpatient setting,$5.58 ,$50.40 ,$226.50
Outpatient Medical Services,LAB,86140,CRP,302,$29.00 ,$23.20 ,80% of billed charges for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$2.59 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.95 ,55% of total billed charges for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$21.75 ,75% of total 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,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.75 ,75% of total billed charges for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$5.18 ,100% UHC fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$8.28 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$23.20 ,80% of total billed charges for outpatient setting,$2.59 ,$23.20 ,$226.50
Outpatient Medical Services,LAB,86300,CA 15-3,302,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.40 ,$93.60 ,$226.50
Outpatient Medical Services,LAB,86300,CA 27-29,302,$124.00 ,$99.20 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.20 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$99.20 ,80% of total billed charges for outpatient setting,$93.00 ,75% of total billed charges for outpatient setting,$93.00 ,75% of total billed charges for outpatient setting,$93.00 ,75% of total billed charges for outpatient setting,$93.00 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.20 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.00 ,75% of total billed charges for outpatient setting,$99.20 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$99.20 ,80% of total billed charges for outpatient setting,$10.40 ,$99.20 ,$226.50
Outpatient Medical Services,LAB,86300,CANCER ANTIGEN 15-3,302,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.40 ,$93.60 ,$226.50
Outpatient Medical Services,LAB,86300,CA 15-3 NELHC,302,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.40 ,$93.60 ,$226.50
Outpatient Medical Services,LAB,86300,CA 15-3,982,$117.00 ,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$20.81 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$70.20 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,100% CMS RBRVS fee schedule for physician setting,N/A,100% CMS RBRVS fee schedule for physician setting,N/A,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,,Not separately reimbursable,$20.81 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,$20.81 ,100% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,$29.13 ,140% CMS RBRVS fee schedule for physician setting,$20.81 ,100% CMS RBRVS fee schedule for physician setting,$33.30 ,160% CMS RBRVS fee schedule for physician setting,N/A,Not separately reimbursable,$20.81 ,$70.20 ,$736.50
Outpatient Medical Services,LAB,86301,CA 19-9,302,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.40 ,$93.60 ,$226.50
Outpatient Medical Services,LAB,86304,CA 125,302,$117.00 ,$93.60 ,80% of billed charges for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$73.47 ,135% BCBS fee schedule for outpatient setting,$10.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$64.35 ,55% of total billed charges for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$27.05 ,130% Coventry fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$87.75 ,75% of total billed charges 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,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.75 ,75% of total billed charges for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$20.81 ,100% UHC fee schedule for outpatient setting,$20.81 ,100% LA Medicaid fee schedule for outpatient setting,$33.29 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$20.81 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.21 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$93.60 ,80% of total billed charges for outpatient setting,$10.40 ,$93.60 ,$226.50
Outpatient Medical Services,LAB,86632,CHLAMYDIA AB IGM,302,$98.00 ,$78.40 ,80% of billed charges for outpatient setting,$12.68 ,100% LA Medicaid fee schedule for outpatient setting,$44.85 ,135% BCBS fee schedule for outpatient setting,$44.85 ,135% BCBS fee schedule for outpatient setting,$44.85 ,135% BCBS fee schedule for outpatient setting,$6.34 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.90 ,55% of total billed charges for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$16.48 ,130% Coventry fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.68 ,100% LA Medicaid fee schedule for outpatient setting,$12.68 ,100% LA Medicaid fee schedule for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$12.68 ,100% UHC fee schedule for outpatient setting,$12.68 ,100% LA Medicaid fee schedule for outpatient setting,$20.28 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$12.68 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.02 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$6.34 ,$78.40 ,$226.50
Outpatient Medical Services,LAB,86653,ST.LOUIS ENCEPH AB IGM,300,$72.00 ,$57.60 ,80% of billed charges for outpatient setting,$13.19 ,100% LA Medicaid fee schedule for outpatient setting,$46.58 ,135% BCBS fee schedule for outpatient setting,$46.58 ,135% BCBS fee schedule for outpatient setting,$46.58 ,135% BCBS fee schedule for outpatient setting,$6.59 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.60 ,55% of total billed charges for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$17.15 ,130% Coventry fee schedule for outpatient setting,$57.60 ,80% of total billed charges for outpatient setting,$54.00 ,75% of total billed charges for outpatient setting,$54.00 ,75% of total billed charges for outpatient setting,$54.00 ,75% of total billed charges for outpatient setting,$54.00 ,75% of total 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,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.19 ,100% LA Medicaid fee schedule for outpatient setting,$13.19 ,100% LA Medicaid fee schedule for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.60 ,80% of total billed charges for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$54.00 ,75% of total billed charges for outpatient setting,$57.60 ,80% of total billed charges for outpatient setting,$13.19 ,100% UHC fee schedule for outpatient setting,$13.19 ,100% LA Medicaid fee schedule for outpatient setting,$21.10 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.19 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.78 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$57.60 ,80% of total billed charges for outpatient setting,$6.59 ,$57.60 ,$225.00
Outpatient Medical Services,LAB,86701,HIV,302,$51.50 ,$41.20 ,80% of billed charges for outpatient setting,$8.89 ,100% LA Medicaid fee schedule for outpatient setting,$31.36 ,135% BCBS fee schedule for outpatient setting,$31.36 ,135% BCBS fee schedule for outpatient setting,$31.36 ,135% BCBS fee schedule for outpatient setting,$4.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.33 ,55% of total billed charges for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$11.56 ,130% Coventry fee schedule for outpatient setting,$41.20 ,80% of total billed charges for outpatient setting,$38.63 ,75% of total billed charges for outpatient setting,$38.63 ,75% of total billed charges for outpatient setting,$38.63 ,75% of total billed charges for outpatient setting,$38.63 ,75% of total billed charges for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.89 ,100% LA Medicaid fee schedule for outpatient setting,$8.89 ,100% LA Medicaid fee schedule for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.20 ,80% of total billed charges for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.63 ,75% of total billed charges for outpatient setting,$41.20 ,80% of total billed charges for outpatient setting,$8.89 ,100% UHC fee schedule for outpatient setting,$8.89 ,100% LA Medicaid fee schedule for outpatient setting,$14.22 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.89 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.33 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$41.20 ,80% of total billed charges for outpatient setting,$4.44 ,$41.20 ,$226.50
Outpatient Medical Services,LAB,86788,WEST NILE ANTIBODY,302,$93.00 ,$74.40 ,80% of billed charges for outpatient setting,$16.85 ,100% LA Medicaid fee schedule for outpatient setting,$50.21 ,135% BCBS fee schedule for outpatient setting,$50.21 ,135% BCBS fee schedule for outpatient setting,$50.21 ,135% BCBS fee schedule for outpatient setting,$8.42 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.15 ,55% of total billed charges for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$21.91 ,130% Coventry fee schedule for outpatient setting,$74.40 ,80% of total billed charges for outpatient setting,$69.75 ,75% of total billed charges for outpatient setting,$69.75 ,75% of total billed charges for outpatient setting,$69.75 ,75% of total billed charges for outpatient setting,$69.75 ,75% of total billed charges for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% LA Medicaid fee schedule for outpatient setting,$16.85 ,100% LA Medicaid fee schedule for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.40 ,80% of total billed charges for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$69.75 ,75% of total billed charges for outpatient setting,$74.40 ,80% of total billed charges for outpatient setting,$16.85 ,100% UHC fee schedule for outpatient setting,$16.85 ,100% LA Medicaid fee schedule for outpatient setting,$26.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$25.27 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$74.40 ,80% of total billed charges for outpatient setting,$8.42 ,$74.40 ,$226.50
Outpatient Medical Services,LAB,86803,HEPATITIS C ANTIBODY SCREEN WITH REFLEX,302,$103.00 ,$82.40 ,80% of billed charges for outpatient setting,$14.27 ,100% LA Medicaid fee schedule for outpatient setting,$50.38 ,135% BCBS fee schedule for outpatient setting,$50.38 ,135% BCBS fee schedule for outpatient setting,$50.38 ,135% BCBS fee schedule for outpatient setting,$7.13 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.65 ,55% of total billed charges for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$18.55 ,130% Coventry fee schedule for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,100% LA Medicaid fee schedule for outpatient setting,$14.27 ,100% LA Medicaid fee schedule for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$14.27 ,100% UHC fee schedule for outpatient setting,$14.27 ,100% LA Medicaid fee schedule for outpatient setting,$22.83 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$14.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.40 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$7.13 ,$82.40 ,$226.50
Outpatient Medical Services,LAB,87040,CULTURE-BLOOD,306,$58.00 ,$46.40 ,80% of billed charges for outpatient setting,$10.32 ,100% LA Medicaid fee schedule for outpatient setting,$36.44 ,135% BCBS fee schedule for outpatient setting,$36.44 ,135% BCBS fee schedule for outpatient setting,$36.44 ,135% BCBS fee schedule for outpatient setting,$5.16 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.90 ,55% of total billed charges for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$13.42 ,130% Coventry fee schedule for outpatient setting,$46.40 ,80% of total billed charges for outpatient setting,$43.50 ,75% of total billed charges for outpatient setting,$43.50 ,75% of total billed charges for outpatient setting,$43.50 ,75% of total billed charges for outpatient setting,$43.50 ,75% of total 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,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.32 ,100% LA Medicaid fee schedule for outpatient setting,$10.32 ,100% LA Medicaid fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$46.40 ,80% of total billed charges for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$43.50 ,75% of total billed charges for outpatient setting,$46.40 ,80% of total billed charges for outpatient setting,$10.32 ,100% UHC fee schedule for outpatient setting,$10.32 ,100% LA Medicaid fee schedule for outpatient setting,$16.51 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$10.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$46.40 ,80% of total billed charges for outpatient setting,$5.16 ,$46.40 ,$229.50
Outpatient Medical Services,LAB,87045,CULTURE-STOOL <REPORTABLE>,302,$53.00 ,$42.40 ,80% of billed charges for outpatient setting,$9.44 ,100% LA Medicaid fee schedule for outpatient setting,$33.30 ,135% BCBS fee schedule for outpatient setting,$33.30 ,135% BCBS fee schedule for outpatient setting,$33.30 ,135% BCBS fee schedule for outpatient setting,$4.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.15 ,55% of total billed charges for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$12.27 ,130% Coventry fee schedule for outpatient setting,$42.40 ,80% of total billed charges for outpatient setting,$39.75 ,75% of total billed charges for outpatient setting,$39.75 ,75% of total billed charges for outpatient setting,$39.75 ,75% of total billed charges for outpatient setting,$39.75 ,75% of total 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,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$9.44 ,100% LA Medicaid fee schedule for outpatient setting,$9.44 ,100% LA Medicaid fee schedule for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.40 ,80% of total billed charges for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.75 ,75% of total billed charges for outpatient setting,$42.40 ,80% of total billed charges for outpatient setting,$9.44 ,100% UHC fee schedule for outpatient setting,$9.44 ,100% LA Medicaid fee schedule for outpatient setting,$15.10 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$9.44 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.16 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$42.40 ,80% of total billed charges for outpatient setting,$4.72 ,$42.40 ,$226.50
Outpatient Medical Services,LAB,87070,CULTURE-CERVIX,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-EAR,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-EYE,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-FLUID,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-JOINT,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-NASOPHARYNG,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-SPUTUM,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-UPPER RESPIRATORY,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87070,CULTURE-WOUND,306,$49.00 ,$39.20 ,80% of billed charges for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$30.40 ,135% BCBS fee schedule for outpatient setting,$4.30 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.95 ,55% of total billed charges for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$11.21 ,130% Coventry fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$36.75 ,75% of total 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,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.75 ,75% of total billed charges for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$8.62 ,100% UHC fee schedule for outpatient setting,$8.62 ,100% LA Medicaid fee schedule for outpatient setting,$13.79 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.61 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.92 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$39.20 ,80% of total billed charges for outpatient setting,$4.30 ,$39.20 ,$229.50
Outpatient Medical Services,LAB,87086,CULTURE-URINE,306,$45.00 ,$36.00 ,80% of billed charges for outpatient setting,$8.07 ,100% LA Medicaid fee schedule for outpatient setting,$28.50 ,135% BCBS fee schedule for outpatient setting,$28.50 ,135% BCBS fee schedule for outpatient setting,$28.50 ,135% BCBS fee schedule for outpatient setting,$4.03 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.75 ,55% of total billed charges for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$10.49 ,130% Coventry fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.07 ,100% LA Medicaid fee schedule for outpatient setting,$8.07 ,100% LA Medicaid fee schedule for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.75 ,75% of total billed charges for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$8.07 ,100% UHC fee schedule for outpatient setting,$8.07 ,100% LA Medicaid fee schedule for outpatient setting,$12.91 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$8.07 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,80% of total billed charges for outpatient setting,$4.03 ,$36.00 ,$229.50
Outpatient Medical Services,LAB,87880,STREP,300,$22.00 ,$17.60 ,80% of billed charges for outpatient setting,$16.32 ,100% LA Medicaid fee schedule for outpatient setting,$42.35 ,135% BCBS fee schedule for outpatient setting,$42.35 ,135% BCBS fee schedule for outpatient setting,$42.35 ,135% BCBS fee schedule for outpatient setting,$8.26 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$12.10 ,55% of total billed charges for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$21.49 ,130% Coventry fee schedule for outpatient setting,$17.60 ,80% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$16.50 ,75% of total 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,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.32 ,100% LA Medicaid fee schedule for outpatient setting,$16.32 ,100% LA Medicaid fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$17.60 ,80% of total billed charges for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.50 ,75% of total billed charges for outpatient setting,$17.60 ,80% of total billed charges for outpatient setting,$16.53 ,100% UHC fee schedule for outpatient setting,$16.32 ,100% LA Medicaid fee schedule for outpatient setting,$26.44 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$16.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.79 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$17.60 ,80% of total billed charges for outpatient setting,$8.26 ,$42.35 ,$225.00
Outpatient Medical Services,LAB,86757,ROCKY MOUNTAIN SPOTTED FEVER IgM,302,$60.00 ,$48.00 ,80% of billed charges for outpatient setting,$19.35 ,100% LA Medicaid fee schedule for outpatient setting,$68.36 ,135% BCBS fee schedule for outpatient setting,$68.36 ,135% BCBS fee schedule for outpatient setting,$68.36 ,135% BCBS fee schedule for outpatient setting,$9.67 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,55% of total billed charges for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$25.16 ,130% Coventry fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total 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,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.35 ,100% LA Medicaid fee schedule for outpatient setting,$19.35 ,100% LA Medicaid fee schedule for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$19.35 ,100% UHC fee schedule for outpatient setting,$19.35 ,100% LA Medicaid fee schedule for outpatient setting,$30.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$19.35 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.02 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$9.67 ,$68.36 ,$226.50
Outpatient Medical Services,LAB,86735,MUMPS TITER IGM,302,$89.00 ,$71.20 ,80% of billed charges for outpatient setting,$13.05 ,100% LA Medicaid fee schedule for outpatient setting,$46.08 ,135% BCBS fee schedule for outpatient setting,$46.08 ,135% BCBS fee schedule for outpatient setting,$46.08 ,135% BCBS fee schedule for outpatient setting,$6.52 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.95 ,55% of total billed charges for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$16.97 ,130% Coventry fee schedule for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.05 ,100% LA Medicaid fee schedule for outpatient setting,$13.05 ,100% LA Medicaid fee schedule for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$66.75 ,75% of total billed charges for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$13.05 ,100% UHC fee schedule for outpatient setting,$13.05 ,100% LA Medicaid fee schedule for outpatient setting,$20.88 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.57 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$71.20 ,80% of total billed charges for outpatient setting,$6.52 ,$71.20 ,$226.50
Outpatient Medical Services,LAB,86710,INFLUENZA A&B AB QUANTITATIVE,302,$125.00 ,$100.00 ,80% of billed charges for outpatient setting,$13.55 ,100% LA Medicaid fee schedule for outpatient setting,$47.86 ,135% BCBS fee schedule for outpatient setting,$47.86 ,135% BCBS fee schedule for outpatient setting,$47.86 ,135% BCBS fee schedule for outpatient setting,$6.77 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$68.75 ,55% of total billed charges for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$17.62 ,130% Coventry fee schedule for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.55 ,100% LA Medicaid fee schedule for outpatient setting,$13.55 ,100% LA Medicaid fee schedule for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$13.55 ,100% UHC fee schedule for outpatient setting,$13.55 ,100% LA Medicaid fee schedule for outpatient setting,$21.68 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.32 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$6.77 ,$100.00 ,$226.50
Outpatient Medical Services,LAB,86308,RAPID MONO,302,$33.00 ,$26.40 ,80% of billed charges for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$18.27 ,135% BCBS fee schedule for outpatient setting,$2.59 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.15 ,55% of total billed charges for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$6.73 ,130% Coventry fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total 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,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$5.18 ,100% UHC fee schedule for outpatient setting,$5.18 ,100% LA Medicaid fee schedule for outpatient setting,$8.28 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.77 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$2.59 ,$26.40 ,$226.50
Outpatient Medical Services,LAB,86376,LIVER-KIDNEY MICROSOMAL ABS,302,$98.00 ,$78.40 ,80% of billed charges for outpatient setting,$14.55 ,100% LA Medicaid fee schedule for outpatient setting,$51.38 ,135% BCBS fee schedule for outpatient setting,$51.38 ,135% BCBS fee schedule for outpatient setting,$51.38 ,135% BCBS fee schedule for outpatient setting,$7.27 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$53.90 ,55% of total billed charges for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$18.92 ,130% Coventry fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.55 ,100% LA Medicaid fee schedule for outpatient setting,$14.55 ,100% LA Medicaid fee schedule for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$73.50 ,75% of total billed charges for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$14.55 ,100% UHC fee schedule for outpatient setting,$14.55 ,100% LA Medicaid fee schedule for outpatient setting,$23.28 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$14.55 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$78.40 ,80% of total billed charges for outpatient setting,$7.27 ,$78.40 ,$226.50
Outpatient Medical Services,RADIOLOGY,70150,XR FACIAL BONES COMP MIN 3 VIEWS,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,70160,XR NASAL BONES COMP MIN 3 VIEWS,320,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,70210,XR SINUSES <3 VIEWS,320,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,70220,XR SINUSES COMP MIN 3 VIEWS,320,$172.00 ,$137.60 ,80% of billed charges for outpatient setting,$69.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$94.60 ,55% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$137.60 ,80% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$69.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$69.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.60 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$129.00 ,75% of total billed charges for outpatient setting,$137.60 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$69.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$137.60 ,80% of total billed charges for outpatient setting,$69.21 ,$137.60 ,$240.00
Outpatient Medical Services,RADIOLOGY,70250,XR SKULL <4 VIEWS,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,70260,XR SKULL COMP MIN 4 VIEWS,320,$265.00 ,$212.00 ,80% of billed charges for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$145.75 ,55% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$92.18 ,$212.00 ,$240.00
Outpatient Medical Services,RADIOLOGY,70360,XR SOFT TISSUE NECK,320,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,70450,CT BRAIN WITHOUT,351,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$263.25
Outpatient Medical Services,RADIOLOGY,70470,CT BRAIN WITH & WO,351,"$1,850.00 ","$1,480.00 ",80% of billed charges for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$618.46 ,135% BCBS fee schedule for outpatient setting,$618.46 ,135% BCBS fee schedule for outpatient setting,$618.46 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,480.00 ",$263.25
Outpatient Medical Services,RADIOLOGY,70486,CT SINUSES WITHOUT,351,"$1,476.00 ","$1,180.80 ",80% of billed charges for outpatient setting,$593.94 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,180.80 ",80% of total billed charges for outpatient setting,"$1,107.00 ",75% of total billed charges for outpatient setting,"$1,107.00 ",75% of total billed charges for outpatient setting,"$1,107.00 ",75% of total billed charges for outpatient setting,"$1,107.00 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$593.94 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$593.94 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,180.80 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,107.00 ",75% of total billed charges for outpatient setting,"$1,180.80 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$593.94 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,180.80 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,180.80 ",$263.25
Outpatient Medical Services,RADIOLOGY,70487,CT SINUSES WITH,351,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$495.50 ,135% BCBS fee schedule for outpatient setting,$495.50 ,135% BCBS fee schedule for outpatient setting,$495.50 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$263.25
Outpatient Medical Services,RADIOLOGY,70490,CT NECK WITHOUT,351,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$413.19 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$263.25
Outpatient Medical Services,RADIOLOGY,70491,CT NECK WITH,351,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$495.50 ,135% BCBS fee schedule for outpatient setting,$495.50 ,135% BCBS fee schedule for outpatient setting,$495.50 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$263.25
Outpatient Medical Services,RADIOLOGY,70492,CT NECK WITH & WO,351,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$618.46 ,135% BCBS fee schedule for outpatient setting,$618.46 ,135% BCBS fee schedule for outpatient setting,$618.46 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$263.25
Outpatient Medical Services,RADIOLOGY,70496,CTA HEAD,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,70498,CTA NECK,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,70544,MRA HEAD W/O CONTRAST,615,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,976.80 ",$461.25
Outpatient Medical Services,RADIOLOGY,70546,MRA HEAD W/WO CONTRAST,615,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$461.25
Outpatient Medical Services,RADIOLOGY,70547,MRA NECK W/O CONTRAST,615,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,976.80 ",$461.25
Outpatient Medical Services,RADIOLOGY,70551,MRI BRAIN W/O CONTRAST,610,"$3,471.00 ","$2,776.80 ",80% of billed charges for outpatient setting,"$1,396.73 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,776.80 ",80% of total billed charges for outpatient setting,"$2,603.25 ",75% of total billed charges for outpatient setting,"$2,603.25 ",75% of total billed charges for outpatient setting,"$2,603.25 ",75% of total billed charges for outpatient setting,"$2,603.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,396.73 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,396.73 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,776.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,603.25 ",75% of total billed charges for outpatient setting,"$2,776.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,"$1,396.73 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,776.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$2,776.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,70552,MRI BRAIN W/CONTRAST,610,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.49 ,135% BCBS fee schedule for outpatient setting,$876.49 ,135% BCBS fee schedule for outpatient setting,$876.49 ,135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,70553,MRI BRAIN W/AND/WO CONTRAST,610,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,71045,XR CHEST 1 VIEW*,324,$65.00 ,$52.00 ,80% of billed charges for outpatient setting,$26.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$35.75 ,55% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$52.00 ,80% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$26.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$52.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.75 ,75% of total billed charges for outpatient setting,$52.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$26.16 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.38 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.36 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$52.00 ,80% of total billed charges for outpatient setting,$26.16 ,$129.44 ,$243.00
Outpatient Medical Services,RADIOLOGY,71046,XR CHEST 2 VIEWS*,324,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.38 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.36 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$243.00
Outpatient Medical Services,RADIOLOGY,71100,XR RIBS UNILATERAL 2 VIEW LT,324,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$243.00
Outpatient Medical Services,RADIOLOGY,71110,XR RIBS BILATERAL 3 VIEW,324,$266.00 ,$212.80 ,80% of billed charges for outpatient setting,$107.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$146.30 ,55% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$212.80 ,80% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$107.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$107.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$212.80 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$199.50 ,75% of total billed charges for outpatient setting,$212.80 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$107.04 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$212.80 ,80% of total billed charges for outpatient setting,$75.15 ,$212.80 ,$243.00
Outpatient Medical Services,RADIOLOGY,71120,XR STERNUM MIN 2 VIEW,324,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$243.00
Outpatient Medical Services,RADIOLOGY,71250,CT CHEST WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,71260,CT CHEST WITH,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$603.45 ,135% BCBS fee schedule for outpatient setting,$603.45 ,135% BCBS fee schedule for outpatient setting,$603.45 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,71270,CT CHEST WITH & WO,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$717.78 ,135% BCBS fee schedule for outpatient setting,$717.78 ,135% BCBS fee schedule for outpatient setting,$717.78 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,71275,CT CTA CHEST W/,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,72040,XR CERVICAL SPINE 2 OR 3 VIEWS,320,$74.00 ,$59.20 ,80% of billed charges for outpatient setting,$29.78 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.70 ,55% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$59.20 ,80% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.78 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$29.78 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.20 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.50 ,75% of total billed charges for outpatient setting,$59.20 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$29.78 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$59.20 ,80% of total billed charges for outpatient setting,$29.78 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,72050,XR CERVICAL SPINE MIN 4 VIEW,324,$103.00 ,$82.40 ,80% of billed charges for outpatient setting,$41.45 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.65 ,55% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.45 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$41.45 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.25 ,75% of total billed charges for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$41.45 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$82.40 ,80% of total billed charges for outpatient setting,$41.45 ,$174.35 ,$243.00
Outpatient Medical Services,RADIOLOGY,72070,XR THORACIC SPINE 2 VIEW,324,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$174.35 ,$243.00
Outpatient Medical Services,RADIOLOGY,72082,XR SCOLIOSIS 2V,320,$276.00 ,$220.80 ,80% of billed charges for outpatient setting,$111.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$86.31 ,135% BCBS fee schedule for outpatient setting,$86.31 ,135% BCBS fee schedule for outpatient setting,$86.31 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$151.80 ,55% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$220.80 ,80% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$111.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$111.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$220.80 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$207.00 ,75% of total billed charges for outpatient setting,$220.80 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$111.06 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$220.80 ,80% of total billed charges for outpatient setting,$86.31 ,$220.80 ,$240.00
Outpatient Medical Services,RADIOLOGY,72100,XR LUMBAR SPINE 2 OR 3 VIEW,320,$128.00 ,$102.40 ,80% of billed charges for outpatient setting,$51.51 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$70.40 ,55% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$102.40 ,80% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$51.51 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$51.51 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$102.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$96.00 ,75% of total billed charges for outpatient setting,$102.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$51.51 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$102.40 ,80% of total billed charges for outpatient setting,$51.51 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,72110,XR LUMBAR SPINE 5 VIEWS,324,$99.00 ,$79.20 ,80% of billed charges for outpatient setting,$39.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$54.45 ,55% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$39.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$39.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.25 ,75% of total billed charges for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$39.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$79.20 ,80% of total billed charges for outpatient setting,$39.84 ,$174.35 ,$243.00
Outpatient Medical Services,RADIOLOGY,72125,CT C-SPINE WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,72128,CT T-SPINE WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,72131,CT L-SPINE WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,72141,MRI CER/SPINE W/O CONTRAST,612,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,976.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,72146,MRI THOR/SPINE W/O CONTRAST,612,"$2,721.00 ","$2,176.80 ",80% of billed charges for outpatient setting,"$1,094.93 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,176.80 ",80% of total billed charges for outpatient setting,"$2,040.75 ",75% of total billed charges for outpatient setting,"$2,040.75 ",75% of total billed charges for outpatient setting,"$2,040.75 ",75% of total billed charges for outpatient setting,"$2,040.75 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,094.93 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,094.93 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,176.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,040.75 ",75% of total billed charges for outpatient setting,"$2,176.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,"$1,094.93 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,176.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$2,176.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,72148,MRI LUMB/SPINE W/O CONTRAST,612,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,976.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,72149,MRI SPINAL CANAL LUMBAR W/CONTRAST,610,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$876.49 ,135% BCBS fee schedule for outpatient setting,$876.49 ,135% BCBS fee schedule for outpatient setting,$876.49 ,135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,72156,MRI CER/SPINE W/WO/CONTRAST,612,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,72158,MRI LUMB/SPINE W/WO/CONTRAST,612,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,72170,XR PELVIS 1 OR 2 VIEW,324,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$174.35 ,$243.00
Outpatient Medical Services,RADIOLOGY,72192,CT PELVIS WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS WITH,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$598.55 ,135% BCBS fee schedule for outpatient setting,$598.55 ,135% BCBS fee schedule for outpatient setting,$598.55 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,73000,CLAVICLE,320,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73010,XR SCAPULA,320,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,73030,XR SHOULDER COMPLETE MIN 2 VIEW RT,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$240.00
Outpatient Medical Services,RADIOLOGY,73060,HUMERUS X-RAY,320,$75.00 ,$60.00 ,80% of billed charges for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.25 ,55% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$30.18 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73070,ELBOW X-RAY,320,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73080,XR ELBOW 3 VIEWS OR MORE,320,$100.00 ,$80.00 ,80% of billed charges for outpatient setting,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$55.00 ,55% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$40.24 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73090,FOREARM XRAY,320,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73110,XR WRIST 2 VIEWS,320,$60.00 ,$48.00 ,80% of billed charges for outpatient setting,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$33.00 ,55% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$24.14 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73130,XR HAND 3 VIEWS,320,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$36.22 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73521,XR HIP BILATERAL AND PELVIS 2 VIEWS,320,$188.00 ,$150.40 ,80% of billed charges for outpatient setting,$75.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.83 ,135% BCBS fee schedule for outpatient setting,$52.83 ,135% BCBS fee schedule for outpatient setting,$52.83 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$103.40 ,55% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$150.40 ,80% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$75.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$150.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$141.00 ,75% of total billed charges for outpatient setting,$150.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$75.65 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$150.40 ,80% of total billed charges for outpatient setting,$52.83 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,73562,KNEE 3 VIEWS,320,$75.00 ,$60.00 ,80% of billed charges for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$41.25 ,55% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$56.25 ,75% of total billed charges for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$30.18 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$60.00 ,80% of total billed charges for outpatient setting,$30.18 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73565,XR BILATERAL STANDING KNEES AP ONLY,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$240.00
Outpatient Medical Services,RADIOLOGY,73590,XR TIBIA/FIBULA 2 VIEW,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$142.40 ,$240.00
Outpatient Medical Services,RADIOLOGY,73610,XR ANKLE COMPLETE 3 VIEW  LT,320,$175.00 ,$140.00 ,80% of billed charges for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$96.25 ,55% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$70.42 ,$140.00 ,$240.00
Outpatient Medical Services,RADIOLOGY,73620,XR FOOT-2 VIEWS,320,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73650,XR HEEL MIN 2 VIEWS,320,$158.00 ,$126.40 ,80% of billed charges for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$86.90 ,55% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.50 ,75% of total billed charges for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$63.58 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$126.40 ,80% of total billed charges for outpatient setting,$63.58 ,$129.44 ,$240.00
Outpatient Medical Services,RADIOLOGY,73700,CT LOWER EXT WITHOUT,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$432.90 ,135% BCBS fee schedule for outpatient setting,$432.90 ,135% BCBS fee schedule for outpatient setting,$432.90 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,73721LT,MRI LOWER EXT JOINT W/O CONTRAST LT,610,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",Not separately reimbursable per CMS guidelines,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,"$1,976.80 ",80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$1,976.80 ",80% of total billed charges for outpatient setting,$994.33 ,"$1,976.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,73721RT,MRI LOWER EXT JOINT W/O CONTRAST RT,610,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",50% of total billed charges for outpatient setting,"$1,235.50 ",Not separately reimbursable per CMS guidelines,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,"$1,976.80 ",80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,"$1,976.80 ",80% of total billed charges for outpatient setting,$994.33 ,"$1,976.80 ",$457.50
Outpatient Medical Services,RADIOLOGY,74019,XR ABD 2 VIEW (FLAT AND ERECT)*,320,$178.00 ,$142.40 ,80% of billed charges for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$75.15 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$97.90 ,55% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$133.50 ,75% of total billed charges for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$71.63 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$142.40 ,80% of total billed charges for outpatient setting,$71.63 ,$174.35 ,$240.00
Outpatient Medical Services,RADIOLOGY,74022,XR ACUTE ABD SERIES+1V CHEST*,320,$265.00 ,$212.00 ,80% of billed charges for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$127.89 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$145.75 ,55% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$198.75 ,75% of total billed charges for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$106.64 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$212.00 ,80% of total billed charges for outpatient setting,$92.18 ,$212.00 ,$240.00
Outpatient Medical Services,RADIOLOGY,74150,CT ABDOMEN WI,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$444.39 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$92.18 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,74160,CT ABDOMEN WI,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$598.55 ,135% BCBS fee schedule for outpatient setting,$598.55 ,135% BCBS fee schedule for outpatient setting,$598.55 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,74170,CT ABDOMEN WI,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$717.78 ,135% BCBS fee schedule for outpatient setting,$717.78 ,135% BCBS fee schedule for outpatient setting,$717.78 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.54 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$155.54 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,74174,CTA ABD & PELVIS W/WO CONTRAST,352,"$1,528.00 ","$1,222.40 ",80% of billed charges for outpatient setting,$614.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$996.60 ,135% BCBS fee schedule for outpatient setting,$996.60 ,135% BCBS fee schedule for outpatient setting,$996.60 ,135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,222.40 ",80% of total billed charges for outpatient setting,"$1,146.00 ",75% of total billed charges for outpatient setting,"$1,146.00 ",75% of total billed charges for outpatient setting,"$1,146.00 ",75% of total billed charges for outpatient setting,"$1,146.00 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$614.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$614.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,222.40 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,146.00 ",75% of total billed charges for outpatient setting,"$1,222.40 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,$614.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,222.40 ",80% of total billed charges for outpatient setting,$317.76 ,"$1,222.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,74176,CT ABD AND PELVIS WO CONTRAST,352,"$1,473.00 ","$1,178.40 ",80% of billed charges for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$564.42 ,135% BCBS fee schedule for outpatient setting,$564.42 ,135% BCBS fee schedule for outpatient setting,$564.42 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,104.75 ",75% of total billed charges for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$592.74 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,178.40 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,178.40 ",$264.00
Outpatient Medical Services,RADIOLOGY,74177,CT ABD AND PELVIS WITH CONTRAST,352,"$2,830.00 ","$2,264.00 ",80% of billed charges for outpatient setting,"$1,138.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$767.30 ,135% BCBS fee schedule for outpatient setting,$767.30 ,135% BCBS fee schedule for outpatient setting,$767.30 ,135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$2,264.00 ",80% of total billed charges for outpatient setting,"$2,122.50 ",75% of total billed charges for outpatient setting,"$2,122.50 ",75% of total billed charges for outpatient setting,"$2,122.50 ",75% of total billed charges for outpatient setting,"$2,122.50 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,138.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,138.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,264.00 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,122.50 ",75% of total billed charges for outpatient setting,"$2,264.00 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,138.79 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,264.00 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,264.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,74178,CT ABD AND PELVIS WITH/WO CONTRAST,352,"$2,200.00 ","$1,760.00 ",80% of billed charges for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$999.18 ,135% BCBS fee schedule for outpatient setting,$999.18 ,135% BCBS fee schedule for outpatient setting,$999.18 ,135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,650.00 ",75% of total billed charges for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,$885.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,760.00 ",80% of total billed charges for outpatient setting,$317.76 ,"$1,760.00 ",$264.00
Outpatient Medical Services,RADIOLOGY,74181,MRI ABDOMEN W/O CONTRAST,612,"$2,471.00 ","$1,976.80 ",80% of billed charges for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$824.99 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,853.25 ",75% of total billed charges for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$368.21 ,100% UHC fee schedule for outpatient setting,$994.33 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,976.80 ",80% of total billed charges for outpatient setting,$201.40 ,"$1,976.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,74183,MRI ABD W/WO CONTRAST,612,"$3,481.00 ","$2,784.80 ",80% of billed charges for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,"$1,196.05 ",135% BCBS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,150.00 ",100% Cigna MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$1,050.00 ",100% Coventry MRI case rate for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$317.76 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,610.75 ",75% of total billed charges for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$588.99 ,100% UHC fee schedule for outpatient setting,"$1,400.75 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$544.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$340.32 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$510.48 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,784.80 ",80% of total billed charges for outpatient setting,$317.76 ,"$2,784.80 ",$459.00
Outpatient Medical Services,RADIOLOGY,75635,CTA ABD  AORTA W RUNOFF,352,"$1,504.00 ","$1,203.20 ",80% of billed charges for outpatient setting,$605.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$702.19 ,135% BCBS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$650.00 ,100% Cigna case rate for CT in outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,$575.00 ,100% Coventry CT case rate for outpatient setting,"$1,203.20 ",80% of total billed charges for outpatient setting,"$1,128.00 ",75% of total billed charges for outpatient setting,"$1,128.00 ",75% of total billed charges for outpatient setting,"$1,128.00 ",75% of total billed charges for outpatient setting,"$1,128.00 ",75% of total billed charges for outpatient setting,$155.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$155.53 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$605.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$605.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,203.20 ",80% of total billed charges for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,128.00 ",75% of total billed charges for outpatient setting,"$1,203.20 ",80% of total billed charges for outpatient setting,$285.68 ,100% UHC fee schedule for outpatient setting,$605.21 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$266.52 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$166.58 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$249.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,203.20 ",80% of total billed charges for outpatient setting,$155.53 ,"$1,203.20 ",$264.00
Outpatient Medical Services,RADIOLOGY,76536,US SOFT TISSUES OF NECK,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76642,US BILATERAL OR UNILATERAL BREAST,402,$218.00 ,$174.40 ,80% of billed charges for outpatient setting,$87.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$102.28 ,135% BCBS fee schedule for outpatient setting,$102.28 ,135% BCBS fee schedule for outpatient setting,$102.28 ,135% BCBS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$119.90 ,55% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$174.40 ,80% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$74.93 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$87.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$87.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.40 ,80% of total billed charges for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$163.50 ,75% of total billed charges for outpatient setting,$174.40 ,80% of total billed charges for outpatient setting,$129.44 ,100% UHC fee schedule for outpatient setting,$87.72 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$128.40 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$80.25 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$120.37 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$174.40 ,80% of total billed charges for outpatient setting,$74.93 ,$174.40 ,$301.50
Outpatient Medical Services,RADIOLOGY,76700,US UPPER ABDOMEN COMPLETE,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$173.04 ,135% BCBS fee schedule for outpatient setting,$173.04 ,135% BCBS fee schedule for outpatient setting,$173.04 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76705,US ABD LIMITED,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76770,US AORTA COMPLETE,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$173.04 ,135% BCBS fee schedule for outpatient setting,$173.04 ,135% BCBS fee schedule for outpatient setting,$173.04 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76830,US TRANSVAG PELVIS,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76805,US OB > OR = 14 WEEKS,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$184.73 ,135% BCBS fee schedule for outpatient setting,$184.73 ,135% BCBS fee schedule for outpatient setting,$184.73 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76856,US PELVIS / TRANS VAGINAL,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76857,US PELVIC WALL BUTTOCK PERINEUM ST,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$139.60 ,135% BCBS fee schedule for outpatient setting,$139.60 ,135% BCBS fee schedule for outpatient setting,$139.60 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,76870,US SCROTUM/TESTICULAR,402,$337.00 ,$269.60 ,80% of billed charges for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$163.59 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$185.35 ,55% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$252.75 ,75% of total billed charges for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$174.35 ,100% UHC fee schedule for outpatient setting,$135.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.09 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$269.60 ,80% of total billed charges for outpatient setting,$92.18 ,$269.60 ,$301.50
Outpatient Medical Services,RADIOLOGY,77063,MM SCREENING DIG BREAST TOMO BIL,403,$148.00 ,$118.40 ,80% of billed charges for outpatient setting,$59.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$18.87 ,135% BCBS fee schedule for outpatient setting,$18.87 ,135% BCBS fee schedule for outpatient setting,$18.87 ,135% BCBS fee schedule for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$81.40 ,55% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$118.40 ,80% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$59.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$59.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$118.40 ,80% of total billed charges for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$111.00 ,75% of total billed charges for outpatient setting,$118.40 ,80% of total billed charges for outpatient setting,$40.75 ,100% UHC fee schedule for outpatient setting,$59.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$34.19 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$21.37 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.06 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$118.40 ,80% of total billed charges for outpatient setting,$18.87 ,$118.40 ,$302.25
Outpatient Medical Services,RADIOLOGY,77065,MM MAMMOGRAM DIAGNOSTIC UNILATERAL LT*,401,$349.00 ,$279.20 ,80% of billed charges for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.95 ,55% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$146.27 ,100% UHC fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$124.58 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.79 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,$279.20 ,$300.75
Outpatient Medical Services,RADIOLOGY,77065,MM Mammo 3D Diag Unilateral LT,401,$349.00 ,$279.20 ,80% of billed charges for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.95 ,55% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$146.27 ,100% UHC fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$124.58 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.79 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,$279.20 ,$300.75
Outpatient Medical Services,RADIOLOGY,77065,MM Mammo 3D Diag Unilateral RT,401,$349.00 ,$279.20 ,80% of billed charges for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$127.91 ,135% BCBS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$191.95 ,55% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$261.75 ,75% of total billed charges for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$146.27 ,100% UHC fee schedule for outpatient setting,$140.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$124.58 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$77.86 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$116.79 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$279.20 ,80% of total billed charges for outpatient setting,$77.86 ,$279.20 ,$300.75
Outpatient Medical Services,RADIOLOGY,93925,US ART DOP COMPLETE BILAT LOWER EXT,921,$748.00 ,$598.40 ,80% of billed charges for outpatient setting,$301.00 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$389.91 ,135% BCBS fee schedule for outpatient setting,$389.91 ,135% BCBS fee schedule for outpatient setting,$389.91 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$411.40 ,55% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$598.40 ,80% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$301.00 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$301.00 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$598.40 ,80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$561.00 ,75% of total billed charges for outpatient setting,$598.40 ,80% of total billed charges for outpatient setting,$598.40 ,80% of total billed charges for outpatient setting,$301.00 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$598.40 ,80% of total billed charges for outpatient setting,$201.40 ,$598.40 ,$690.75
Outpatient Medical Services,RADIOLOGY,93970,US VENOUS DOPPLER COMPLETE BILAT,921,$588.00 ,$470.40 ,80% of billed charges for outpatient setting,$236.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$389.91 ,135% BCBS fee schedule for outpatient setting,$389.91 ,135% BCBS fee schedule for outpatient setting,$389.91 ,135% BCBS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.40 ,55% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$470.40 ,80% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.40 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$236.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$236.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$470.40 ,80% of total billed charges for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$441.00 ,75% of total billed charges for outpatient setting,$470.40 ,80% of total billed charges for outpatient setting,$470.40 ,80% of total billed charges for outpatient setting,$236.61 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$345.12 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$215.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$323.55 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$470.40 ,80% of total billed charges for outpatient setting,$201.40 ,$470.40 ,$690.75
Outpatient Medical Services,RADIOLOGY,93971,US VENOUS DOPPLER-UNILAT,921,$402.00 ,$321.60 ,80% of billed charges for outpatient setting,$161.76 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$242.45 ,135% BCBS fee schedule for outpatient setting,$242.45 ,135% BCBS fee schedule for outpatient setting,$242.45 ,135% BCBS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$221.10 ,55% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$321.60 ,80% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$92.18 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$161.76 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$161.76 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$321.60 ,80% of total billed charges for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$301.50 ,75% of total billed charges for outpatient setting,$321.60 ,80% of total billed charges for outpatient setting,$321.60 ,80% of total billed charges for outpatient setting,$161.76 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$157.94 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$98.72 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$321.60 ,80% of total billed charges for outpatient setting,$92.18 ,$321.60 ,$690.75
Outpatient Medical Services,RADIOLOGY,77066,MM MAMMOGRAM DIAGNOSTIC BILATERAL*,401,$443.00 ,$354.40 ,80% of billed charges for outpatient setting,$178.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$150.28 ,135% BCBS fee schedule for outpatient setting,$150.28 ,135% BCBS fee schedule for outpatient setting,$150.28 ,135% BCBS fee schedule for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$243.65 ,55% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$354.40 ,80% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$178.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$178.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$354.40 ,80% of total billed charges for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$332.25 ,75% of total billed charges for outpatient setting,$354.40 ,80% of total billed charges for outpatient setting,$187.02 ,100% UHC fee schedule for outpatient setting,$178.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$158.77 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$99.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$148.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$354.40 ,80% of total billed charges for outpatient setting,$99.23 ,$354.40 ,$300.75
Outpatient Medical Services,RADIOLOGY,77067,MM MAMMOGRAM SCREENING BILATERAL*,403,$350.00 ,$280.00 ,80% of billed charges for outpatient setting,$140.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$143.71 ,135% BCBS fee schedule for outpatient setting,$143.71 ,135% BCBS fee schedule for outpatient setting,$143.71 ,135% BCBS fee schedule for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.50 ,55% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$280.00 ,80% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$140.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$140.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$280.00 ,80% of total billed charges for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$262.50 ,75% of total billed charges for outpatient setting,$280.00 ,80% of total billed charges for outpatient setting,$154.64 ,100% UHC fee schedule for outpatient setting,$140.84 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$131.70 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$82.31 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$123.47 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$280.00 ,80% of total billed charges for outpatient setting,$82.31 ,$280.00 ,$302.25
Outpatient Medical Services,SLEEP,95811,POLYSOMNOGRAM SPLIT NIGHT,920,"$2,550.00 ","$2,040.00 ",80% of billed charges for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,402.50 ",55% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,380.94 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,294.64 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,$805.88 ,"$2,040.00 ",$690.00
Outpatient Medical Services,SLEEP,95811,POLYSOMNOGRAM W/CPAP,920,"$2,550.00 ","$2,040.00 ",80% of billed charges for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,402.50 ",55% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,912.50 ",75% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,"$1,026.12 ",40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,380.94 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,294.64 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$2,040.00 ",80% of total billed charges for outpatient setting,$805.88 ,"$2,040.00 ",$690.00
Outpatient Medical Services,SLEEP,95782,POLYSOMNOGRAM  <6,920,"$1,442.00 ","$1,153.60 ",80% of billed charges for outpatient setting,$580.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,131.00 ",135% BCBS fee schedule for outpatient setting,"$2,131.00 ",135% BCBS fee schedule for outpatient setting,"$2,131.00 ",135% BCBS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$793.10 ,55% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,153.60 ",80% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$580.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$580.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,153.60 ",80% of total billed charges for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,081.50 ",75% of total billed charges for outpatient setting,"$1,153.60 ",80% of total billed charges for outpatient setting,"$1,153.60 ",80% of total billed charges for outpatient setting,$580.26 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,380.94 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,294.64 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,153.60 ",80% of total billed charges for outpatient setting,$580.26 ,"$2,131.00 ",$690.00
Outpatient Medical Services,SLEEP,95783,POLYSOMNOGRAM SPLIT NIGHT <6,920,"$1,850.00 ","$1,480.00 ",80% of billed charges for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$2,218.91 ",135% BCBS fee schedule for outpatient setting,"$2,218.91 ",135% BCBS fee schedule for outpatient setting,"$2,218.91 ",135% BCBS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,017.50 ",55% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,387.50 ",75% of total billed charges for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$744.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,380.94 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,294.64 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,480.00 ",80% of total billed charges for outpatient setting,$744.44 ,"$2,218.91 ",$690.00
Outpatient Medical Services,SLEEP,95810,POLYSOMNOGRAM,920,"$2,336.00 ","$1,868.80 ",80% of billed charges for outpatient setting,$940.01 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,"$1,360.50 ",135% BCBS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,284.80 ",55% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,868.80 ",80% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$805.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$940.01 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$940.01 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,868.80 ",80% of total billed charges for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,752.00 ",75% of total billed charges for outpatient setting,"$1,868.80 ",80% of total billed charges for outpatient setting,"$1,868.80 ",80% of total billed charges for outpatient setting,$940.01 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,"$1,380.94 ",140% CMS Medicare OPPS fee schedule for outpatient setting,$863.09 ,100% CMS Medicare OPPS fee schedule for outpatient setting,"$1,294.64 ",160% CMS Medicare OPPS fee schedule for outpatient setting,"$1,868.80 ",80% of total billed charges for outpatient setting,$805.88 ,"$1,868.80 ",$690.00
Outpatient Medical Services,THERAPY,97161,PT EVALUATION LOW COMPLEXITY,424,$240.00 ,$192.00 ,80% of billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.00 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,$192.00 ,$318.00
Outpatient Medical Services,THERAPY,97162,PT EVALUATION MODERATE COMPLEXITY,424,$240.00 ,$192.00 ,80% of billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.00 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,$192.00 ,$318.00
Outpatient Medical Services,THERAPY,97163,PT EVALUATION HIGH COMPLEXITY,424,$240.00 ,$192.00 ,80% of billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$163.24 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$132.00 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$180.00 ,75% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$192.00 ,80% of total billed charges for outpatient setting,$58.94 ,$192.00 ,$318.00
Outpatient Medical Services,THERAPY,97165,OT EVALUATION LOW COMPLEXITY,434,$250.00 ,$200.00 ,80% of billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,$200.00 ,$325.50
Outpatient Medical Services,THERAPY,97166,OT EVALUATION MODERATE COMPLEXITY,430,$250.00 ,$200.00 ,80% of billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,$200.00 ,$322.50
Outpatient Medical Services,THERAPY,97167,OT EVALUATION HIGH COMPLEXITY,430,$250.00 ,$200.00 ,80% of billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$173.65 ,135% BCBS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$137.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$187.50 ,75% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,100% LA Medicaid fee schedule for outpatient setting,$153.41 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$95.88 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$143.82 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$200.00 ,80% of total billed charges for outpatient setting,$57.26 ,$200.00 ,$322.50
Outpatient Medical Services,THERAPY,97010,HOT/COLD PKS TO ONE OR MORE AREAS,420,$9.00 ,$7.20 ,80% of billed charges for outpatient setting,$3.62 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$8.29 ,135% BCBS fee schedule for outpatient setting,$8.29 ,135% BCBS fee schedule for outpatient setting,$8.29 ,135% BCBS fee schedule for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$4.95 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$7.20 ,80% of total billed charges for outpatient setting,$6.75 ,75% of total billed charges for outpatient setting,$6.75 ,75% of total billed charges for outpatient setting,$6.75 ,75% of total billed charges for outpatient setting,$6.75 ,75% of total billed charges for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$3.62 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$3.62 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$7.20 ,80% of total billed charges for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$6.75 ,75% of total billed charges for outpatient setting,$7.20 ,80% of total billed charges for outpatient setting,$7.20 ,80% of total billed charges for outpatient setting,$3.62 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$9.00 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$5.98 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$8.97 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$7.20 ,80% of total billed charges for outpatient setting,$3.62 ,$70.00 ,$315.00
Outpatient Medical Services,THERAPY,97022,WHIRLPOOL-LARGE,430,$27.00 ,$21.60 ,80% of billed charges for outpatient setting,$10.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$30.98 ,135% BCBS fee schedule for outpatient setting,$30.98 ,135% BCBS fee schedule for outpatient setting,$30.98 ,135% BCBS fee schedule for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.85 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$21.60 ,80% of total billed charges for outpatient setting,$20.25 ,75% of total billed charges for outpatient setting,$20.25 ,75% of total billed charges for outpatient setting,$20.25 ,75% of total billed charges for outpatient setting,$20.25 ,75% of total billed charges for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$10.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$10.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.60 ,80% of total billed charges for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.25 ,75% of total billed charges for outpatient setting,$21.60 ,80% of total billed charges for outpatient setting,$21.60 ,80% of total billed charges for outpatient setting,$10.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$25.50 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$15.94 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$23.91 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$21.60 ,80% of total billed charges for outpatient setting,$10.86 ,$70.00 ,$322.50
Outpatient Medical Services,THERAPY,97032,"OT ELECTRICAL STIMULATION, EACH 15 MINS",430,$39.00 ,$31.20 ,80% of billed charges for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$34.25 ,135% BCBS fee schedule for outpatient setting,$34.25 ,135% BCBS fee schedule for outpatient setting,$34.25 ,135% BCBS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.45 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$22.24 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$13.90 ,$70.00 ,$322.50
Outpatient Medical Services,THERAPY,97032,"PT ELECTRICAL STIMULATION, EACH 15 MINS",420,$39.00 ,$31.20 ,80% of billed charges for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$34.25 ,135% BCBS fee schedule for outpatient setting,$34.25 ,135% BCBS fee schedule for outpatient setting,$34.25 ,135% BCBS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$21.45 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$29.25 ,75% of total billed charges for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$15.69 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$22.24 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$31.20 ,80% of total billed charges for outpatient setting,$13.90 ,$70.00 ,$315.00
Outpatient Medical Services,THERAPY,97016,VASOPNEUMATIC DEV TO ONE OR> AREAS,420,$33.00 ,$26.40 ,80% of billed charges for outpatient setting,$13.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$29.65 ,135% BCBS fee schedule for outpatient setting,$29.65 ,135% BCBS fee schedule for outpatient setting,$29.65 ,135% BCBS fee schedule for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.15 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$13.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$24.75 ,75% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$13.28 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$17.97 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$11.23 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,80% of total billed charges for outpatient setting,$11.23 ,$70.00 ,$315.00
Outpatient Medical Services,THERAPY,97033,IONTOPHORE 1 OR > AREAS; EACH 15 MINS OT,430,$48.00 ,$38.40 ,80% of billed charges for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$43.16 ,135% BCBS fee schedule for outpatient setting,$43.16 ,135% BCBS fee schedule for outpatient setting,$43.16 ,135% BCBS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$29.90 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.04 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$18.69 ,$70.00 ,$322.50
Outpatient Medical Services,THERAPY,97033,IONTOPHORES1 OR > AREAS; EACH 15 MINS PT,420,$48.00 ,$38.40 ,80% of billed charges for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$43.16 ,135% BCBS fee schedule for outpatient setting,$43.16 ,135% BCBS fee schedule for outpatient setting,$43.16 ,135% BCBS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$26.40 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.00 ,75% of total billed charges for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$19.32 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$29.90 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$18.69 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.04 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$38.40 ,80% of total billed charges for outpatient setting,$18.69 ,$70.00 ,$315.00
Outpatient Medical Services,THERAPY,97110,OT THERAPY PROCEDURE 15 MIN,430,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$44.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.15 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$16.21 ,$72.00 ,$322.50
Outpatient Medical Services,THERAPY,97110,PT THERAPEUTIC EXERCISES EACH 15MIN,420,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$60.51 ,135% BCBS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$16.21 ,100% LA Medicaid fee schedule for outpatient setting,$44.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.15 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$16.21 ,$72.00 ,$315.00
Outpatient Medical Services,THERAPY,97112,OT NEUROMUSCULAR RE-ED 15 MIN,430,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$62.52 ,135% BCBS fee schedule for outpatient setting,$62.52 ,135% BCBS fee schedule for outpatient setting,$62.52 ,135% BCBS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$51.47 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.26 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$32.17 ,$72.00 ,$322.50
Outpatient Medical Services,THERAPY,97112,PT NEUROMUSCULAR REEDUCATION EA 15MIN,420,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$62.52 ,135% BCBS fee schedule for outpatient setting,$62.52 ,135% BCBS fee schedule for outpatient setting,$62.52 ,135% BCBS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$51.47 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$32.17 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$48.26 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$32.17 ,$72.00 ,$315.00
Outpatient Medical Services,THERAPY,97116,PT GAIT TRAINING 15 MIN,420,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$53.08 ,135% BCBS fee schedule for outpatient setting,$53.08 ,135% BCBS fee schedule for outpatient setting,$53.08 ,135% BCBS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$44.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.15 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,$72.00 ,$315.00
Outpatient Medical Services,THERAPY,97116,PT GAIT TRAINING EA 15MIN,420,$90.00 ,$72.00 ,80% of billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$53.08 ,135% BCBS fee schedule for outpatient setting,$53.08 ,135% BCBS fee schedule for outpatient setting,$53.08 ,135% BCBS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$49.50 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$67.50 ,75% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$36.22 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$44.96 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$28.10 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$42.15 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$72.00 ,80% of total billed charges for outpatient setting,$28.10 ,$72.00 ,$315.00
Outpatient Medical Services,THERAPY,97012,TRACTION TO 1 > MORE AREAS,430,$36.00 ,$28.80 ,80% of billed charges for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$32.04 ,135% BCBS fee schedule for outpatient setting,$32.04 ,135% BCBS fee schedule for outpatient setting,$32.04 ,135% BCBS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.80 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$22.24 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$13.90 ,$70.00 ,$322.50
Outpatient Medical Services,THERAPY,97012,TRACTION TO 1 > MORE AREAS,420,$36.00 ,$28.80 ,80% of billed charges for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$32.04 ,135% BCBS fee schedule for outpatient setting,$32.04 ,135% BCBS fee schedule for outpatient setting,$32.04 ,135% BCBS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$19.80 ,55% of total billed charges for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$70.00 ,100% Coventry therapy case rate for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$27.00 ,75% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$14.49 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$22.24 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$13.90 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$20.85 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$28.80 ,80% of total billed charges for outpatient setting,$13.90 ,$70.00 ,$315.00
Outpatient Medical Services,VISIT,99201,NEW PT LEVEL 1 OV,521,$100.00 ,$80.00 ,80% of billed charges for outpatient setting,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$50.00 ,50% of total billed charges for outpatient setting,$50.00 ,50% of total billed charges for outpatient setting,$50.00 ,50% of total billed charges for outpatient setting,$50.00 ,Not separately reimbursable per CMS guidelines,$55.00 ,55% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$80.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$80.00 ,80% of total billed charges for outpatient setting,$40.24 ,$80.00 ,$390.75
Outpatient Medical Services,VISIT,99202,NEW PT LEVEL 2 OV,521,$125.00 ,$100.00 ,80% of billed charges for outpatient setting,$50.30 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$62.50 ,Not separately reimbursable per CMS guidelines,$68.75 ,55% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,$93.75 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$50.30 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$50.30 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$100.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$93.75 ,75% of total billed charges for outpatient setting,$100.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$50.30 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$100.00 ,80% of total billed charges for outpatient setting,$50.30 ,$134.33 ,$390.75
Outpatient Medical Services,VISIT,99203,NEW PT LEVEL 3 OV,521,$140.00 ,$112.00 ,80% of billed charges for outpatient setting,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$154.55 ,135% BCBS fee schedule for outpatient setting,$154.55 ,135% BCBS fee schedule for outpatient setting,$154.55 ,135% BCBS fee schedule for outpatient setting,$70.00 ,Not separately reimbursable per CMS guidelines,$77.00 ,55% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$112.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$105.00 ,75% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$112.00 ,80% of total billed charges for outpatient setting,$56.34 ,$154.55 ,$390.75
Outpatient Medical Services,VISIT,99204,NEW PT LEVEL 4 OV,521,$175.00 ,$140.00 ,80% of billed charges for outpatient setting,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$87.50 ,Not separately reimbursable per CMS guidelines,$96.25 ,55% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,$131.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$140.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$131.25 ,75% of total billed charges for outpatient setting,$140.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$70.42 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$140.00 ,80% of total billed charges for outpatient setting,$70.42 ,$224.87 ,$390.75
Outpatient Medical Services,VISIT,99205,NEW PT LEVEL 5 OV,521,$225.00 ,$180.00 ,80% of billed charges for outpatient setting,$90.54 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$112.50 ,Not separately reimbursable per CMS guidelines,$123.75 ,55% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$180.00 ,80% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,$168.75 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$90.54 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$90.54 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$180.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$168.75 ,75% of total billed charges for outpatient setting,$180.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$90.54 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$180.00 ,80% of total billed charges for outpatient setting,$90.54 ,$224.87 ,$390.75
Outpatient Medical Services,VISIT,99211,EST LEVEL 1 OV,521,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$25.00 ,Not separately reimbursable per CMS guidelines,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$40.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$134.33 ,$390.75
Outpatient Medical Services,VISIT,99212,EST LEVEL 2 OV,521,$100.00 ,$80.00 ,80% of billed charges for outpatient setting,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$134.33 ,135% BCBS fee schedule for outpatient setting,$50.00 ,Not separately reimbursable per CMS guidelines,$55.00 ,55% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,$75.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$80.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$75.00 ,75% of total billed charges for outpatient setting,$80.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$40.24 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$80.00 ,80% of total billed charges for outpatient setting,$40.24 ,$134.33 ,$390.75
Outpatient Medical Services,VISIT,99213,RURAL HEALTH VISIT,521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$154.55 ,135% BCBS fee schedule for outpatient setting,$154.55 ,135% BCBS fee schedule for outpatient setting,$154.55 ,135% BCBS fee schedule for outpatient setting,$65.00 ,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$154.55 ,$390.75
Outpatient Medical Services,VISIT,99214,EST LEVEL 4 OV,521,$150.00 ,$120.00 ,80% of billed charges for outpatient setting,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$75.00 ,Not separately reimbursable per CMS guidelines,$82.50 ,55% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$120.00 ,80% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,$112.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$120.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$112.50 ,75% of total billed charges for outpatient setting,$120.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$60.36 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$120.00 ,80% of total billed charges for outpatient setting,$60.36 ,$224.87 ,$390.75
Outpatient Medical Services,VISIT,99215,EST LEVEL 5 OV,521,$200.00 ,$160.00 ,80% of billed charges for outpatient setting,$80.48 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$224.87 ,135% BCBS fee schedule for outpatient setting,$100.00 ,Not separately reimbursable per CMS guidelines,$110.00 ,55% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$160.00 ,80% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,$150.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$80.48 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.48 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$160.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$150.00 ,75% of total billed charges for outpatient setting,$160.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$80.48 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$160.00 ,80% of total billed charges for outpatient setting,$80.48 ,$224.87 ,$390.75
Outpatient Medical Services,VISIT,99381,INT COMP (AGE UNDER 1),521,$51.00 ,$40.80 ,80% of billed charges for outpatient setting,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,Not separately reimbursable per CMS guidelines,$28.05 ,55% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,$20.52 ,$40.80 ,$390.75
Outpatient Medical Services,VISIT,99382,INT COMP (AGE 01-4),521,$51.00 ,$40.80 ,80% of billed charges for outpatient setting,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,Not separately reimbursable per CMS guidelines,$28.05 ,55% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,$20.52 ,$40.80 ,$390.75
Outpatient Medical Services,VISIT,99383,INT COMP (AGE 05-11),521,$51.00 ,$40.80 ,80% of billed charges for outpatient setting,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,50% of total billed charges for outpatient setting,$25.50 ,Not separately reimbursable per CMS guidelines,$28.05 ,55% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,$38.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$38.25 ,75% of total billed charges for outpatient setting,$40.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$20.52 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.80 ,80% of total billed charges for outpatient setting,$20.52 ,$40.80 ,$390.75
Outpatient Medical Services,VISIT,99384,INT COMP (AGE 12-17),521,$140.00 ,$112.00 ,80% of billed charges for outpatient setting,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$70.00 ,50% of total billed charges for outpatient setting,$70.00 ,50% of total billed charges for outpatient setting,$70.00 ,50% of total billed charges for outpatient setting,$70.00 ,Not separately reimbursable per CMS guidelines,$77.00 ,55% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,$105.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$112.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$105.00 ,75% of total billed charges for outpatient setting,$112.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$56.34 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$112.00 ,80% of total billed charges for outpatient setting,$56.34 ,$112.00 ,$390.75
Outpatient Medical Services,VISIT,99385,INT COMP (AGE 18-39),521,$185.00 ,$148.00 ,80% of billed charges for outpatient setting,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,Not separately reimbursable per CMS guidelines,$101.75 ,55% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$148.00 ,80% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$148.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$138.75 ,75% of total billed charges for outpatient setting,$148.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$148.00 ,80% of total billed charges for outpatient setting,$74.44 ,$148.00 ,$390.75
Outpatient Medical Services,VISIT,99386,PREV MED NP 40-64,521,$220.00 ,$176.00 ,80% of billed charges for outpatient setting,$88.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$110.00 ,50% of total billed charges for outpatient setting,$110.00 ,50% of total billed charges for outpatient setting,$110.00 ,50% of total billed charges for outpatient setting,$110.00 ,Not separately reimbursable per CMS guidelines,$121.00 ,55% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$176.00 ,80% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,$165.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$88.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$88.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$176.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$165.00 ,75% of total billed charges for outpatient setting,$176.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$88.53 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$176.00 ,80% of total billed charges for outpatient setting,$88.53 ,$176.00 ,$390.75
Outpatient Medical Services,VISIT,99387,PREV MED NP 65+,521,$235.00 ,$188.00 ,80% of billed charges for outpatient setting,$94.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$117.50 ,50% of total billed charges for outpatient setting,$117.50 ,50% of total billed charges for outpatient setting,$117.50 ,50% of total billed charges for outpatient setting,$117.50 ,Not separately reimbursable per CMS guidelines,$129.25 ,55% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$188.00 ,80% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,$176.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$94.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$94.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$188.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$176.25 ,75% of total billed charges for outpatient setting,$188.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$94.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$188.00 ,80% of total billed charges for outpatient setting,$94.56 ,$188.00 ,$390.75
Outpatient Medical Services,VISIT,99391,PER COMP (AGE UNDER 1),521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$104.00 ,$390.75
Outpatient Medical Services,VISIT,99392,PER COMP (AGE 01-4),521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$104.00 ,$390.75
Outpatient Medical Services,VISIT,99393,PER COMP (AGE 05-11),521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$104.00 ,$390.75
Outpatient Medical Services,VISIT,99394,PER COMP (AGE 12-17),521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$104.00 ,$390.75
Outpatient Medical Services,VISIT,99395,PER COMP (AGE 18-39),521,$160.00 ,$128.00 ,80% of billed charges for outpatient setting,$64.38 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$80.00 ,50% of total billed charges for outpatient setting,$80.00 ,50% of total billed charges for outpatient setting,$80.00 ,50% of total billed charges for outpatient setting,$80.00 ,Not separately reimbursable per CMS guidelines,$88.00 ,55% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$128.00 ,80% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,$120.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$64.38 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$64.38 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$128.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$120.00 ,75% of total billed charges for outpatient setting,$128.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$64.38 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$128.00 ,80% of total billed charges for outpatient setting,$64.38 ,$128.00 ,$390.75
Outpatient Medical Services,VISIT,99396,PREV MED AGE 40-64,521,$170.00 ,$136.00 ,80% of billed charges for outpatient setting,$68.41 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$85.00 ,50% of total billed charges for outpatient setting,$85.00 ,50% of total billed charges for outpatient setting,$85.00 ,50% of total billed charges for outpatient setting,$85.00 ,Not separately reimbursable per CMS guidelines,$93.50 ,55% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,$127.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$68.41 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$68.41 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$136.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$127.50 ,75% of total billed charges for outpatient setting,$136.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$68.41 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$136.00 ,80% of total billed charges for outpatient setting,$68.41 ,$136.00 ,$390.75
Outpatient Medical Services,VISIT,99397,PREV MED AGE 65+,521,$185.00 ,$148.00 ,80% of billed charges for outpatient setting,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,50% of total billed charges for outpatient setting,$92.50 ,Not separately reimbursable per CMS guidelines,$101.75 ,55% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$148.00 ,80% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,$138.75 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$148.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$138.75 ,75% of total billed charges for outpatient setting,$148.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$74.44 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$148.00 ,80% of total billed charges for outpatient setting,$74.44 ,$148.00 ,$390.75
Outpatient Medical Services,VISIT,99499,PHYSICAL EXAM (EMPLOYMENT/SPORTS),521,$130.00 ,$104.00 ,80% of billed charges for outpatient setting,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,$65.00 ,50% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$71.50 ,55% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,$97.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$97.50 ,75% of total billed charges for outpatient setting,$104.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$52.31 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$104.00 ,80% of total billed charges for outpatient setting,$52.31 ,$104.00 ,$390.75
Outpatient Medical Services,VISIT,99441,TELEMED 5-10 MIN AUDIO ONLY,521,$50.00 ,$40.00 ,80% of billed charges for outpatient setting,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$25.00 ,50% of total billed charges for outpatient setting,$25.00 ,50% of total billed charges for outpatient setting,$25.00 ,50% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$27.50 ,55% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,$37.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$40.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$37.50 ,75% of total billed charges for outpatient setting,$40.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$20.12 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$40.00 ,80% of total billed charges for outpatient setting,$20.12 ,$40.00 ,$390.75
Outpatient Medical Services,VISIT,99442,TELEMED 11-20 MIN AUDIO ONLY,521,$60.00 ,$48.00 ,80% of billed charges for outpatient setting,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$30.00 ,50% of total billed charges for outpatient setting,$30.00 ,50% of total billed charges for outpatient setting,$30.00 ,50% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$33.00 ,55% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,$45.00 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$48.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$45.00 ,75% of total billed charges for outpatient setting,$48.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$24.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$48.00 ,80% of total billed charges for outpatient setting,$24.14 ,$48.00 ,$390.75
Outpatient Medical Services,VISIT,99443,TELEMED 21-30 MIN AUDIO ONLY,521,$78.00 ,$62.40 ,80% of billed charges for outpatient setting,$31.39 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$39.00 ,50% of total billed charges for outpatient setting,$39.00 ,50% of total billed charges for outpatient setting,$39.00 ,50% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$42.90 ,55% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$62.40 ,80% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,$58.50 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$31.39 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$31.39 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$62.40 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$58.50 ,75% of total billed charges for outpatient setting,$62.40 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$31.39 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$62.40 ,80% of total billed charges for outpatient setting,$31.39 ,$62.40 ,$390.75
Outpatient Medical Services,VISIT,90832,"PSYCHOTHERAPY, 30 MIN W/PATIENT",914,$196.00 ,$156.80 ,80% of billed charges for outpatient setting,$78.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$98.00 ,50% of total billed charges for outpatient setting,$98.00 ,50% of total billed charges for outpatient setting,$98.00 ,50% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$107.80 ,55% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$156.80 ,80% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$78.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$78.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$156.80 ,80% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$147.00 ,75% of total billed charges for outpatient setting,$156.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$78.87 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.33 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$156.80 ,80% of total billed charges for outpatient setting,$78.87 ,$215.33 ,$685.50
Outpatient Medical Services,VISIT,90834,PSYCHOTHERAPY 45 MIN WITH PATIENT,914,$317.00 ,$253.60 ,80% of billed charges for outpatient setting,$127.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$158.50 ,50% of total billed charges for outpatient setting,$158.50 ,50% of total billed charges for outpatient setting,$158.50 ,50% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$174.35 ,55% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$253.60 ,80% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$127.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$127.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$253.60 ,80% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$237.75 ,75% of total billed charges for outpatient setting,$253.60 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$127.56 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.33 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$253.60 ,80% of total billed charges for outpatient setting,$125.65 ,$253.60 ,$685.50
Outpatient Medical Services,VISIT,90837,PSYCHOTHERAPY 60 MIN WITH PATIENT,914,$393.00 ,$314.40 ,80% of billed charges for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$196.50 ,50% of total billed charges for outpatient setting,$196.50 ,50% of total billed charges for outpatient setting,$196.50 ,50% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$216.15 ,55% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$125.65 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$294.75 ,75% of total billed charges for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$158.14 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$215.33 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$134.57 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$201.87 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$314.40 ,80% of total billed charges for outpatient setting,$125.65 ,$314.40 ,$685.50
Outpatient Medical Services,VISIT,90853,GROUP THERAPY,915,$180.00 ,$144.00 ,80% of billed charges for outpatient setting,$72.43 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$205.08 ,135% BCBS fee schedule for outpatient setting,$205.08 ,135% BCBS fee schedule for outpatient setting,$205.08 ,135% BCBS fee schedule for outpatient setting,$70.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$99.00 ,55% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$144.00 ,80% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$65.41 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$65.41 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$65.41 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$72.43 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$72.43 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$70.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$144.00 ,80% of total billed charges for outpatient setting,$70.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$135.00 ,75% of total billed charges for outpatient setting,$144.00 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$72.43 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$112.10 ,140% CMS Medicare OPPS fee schedule for outpatient setting,$70.05 ,100% CMS Medicare OPPS fee schedule for outpatient setting,$105.08 ,160% CMS Medicare OPPS fee schedule for outpatient setting,$144.00 ,80% of total billed charges for outpatient setting,$65.41 ,$205.08 ,$686.25
Outpatient Medical Services,VISIT,99244,CONSULT OV LEVEL IV,521,$191.00 ,$152.80 ,80% of billed charges for outpatient setting,$76.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$95.50 ,50% of total billed charges for outpatient setting,$95.50 ,50% of total billed charges for outpatient setting,$95.50 ,50% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$105.05 ,55% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$152.80 ,80% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,$143.25 ,75% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$76.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,$76.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,$152.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable per CMS guidelines,$143.25 ,75% of total billed charges for outpatient setting,$152.80 ,80% of total billed charges for outpatient setting,N/A,Not separately reimbursable,$76.86 ,40.24% of billed charges for outpatient setting which is 100% LA Medicaid rate,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,N/A,Not separately reimbursable per CMS guidelines,$152.80 ,80% of total billed charges for outpatient setting,$76.86 ,$152.80 ,$390.75
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,73721,MRI scan of leg joint,610,SERVICE NOT OFFERED,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. 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,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,Not applicable. Service not offered,N/A,N/A,N/A